EDI Encounter Specialist
for sections: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Only include sections that have real specific content. We must not repeat job title as heading. No Job ID etc. Remove boilerplate. Must preserve all substantive info.
We need to parse the posting.
Let's extract sections:
- About the role: description of role: "The EDI Encounter Specialist is responsible for the administration, monitoring, validation, and support of healthcare encounter data submitted to state (AHCA) and CMS, as well as those received from clearinghouses and business partners. This position ensures encounter data is complete, accurate, compliant, and submitted within required regulatory timeframes. The specialist works closely with Claims, IT, Compliance, Finance, Vendor Management, and external vendors to identify, research, and resolve encounter submission issues while maintaining compliance with CMS, AHCA, HIPAA, and ANSI X12 standards."
That's about the role.
- Responsibilities: list of essential responsibilities and healthcare EDI responsibilities and encounter data responsibilities. We'll combine into a list.
- Requirements: maybe "Required Qualifications" and "Preferred Qualifications". Could be separate sections: Requirements (maybe required) and Qualifications (preferred). But we have headings: Requirements, Qualifications, Skills. We need to decide.
The posting includes "Required Qualifications:" bullet list, then "Preferred Qualifications:" bullet list. Also "Typical Daily Activities:" list.
We also have "Healthcare EDI Responsibilities:" and "Encounter Data Responsibilities:" which are more responsibilities.
We need to output sections only if they have real content.
We have content for About the role, Responsibilities (essential responsibilities + healthcare EDI + encounter data + typical daily activities), Requirements (maybe required qualifications), Qualifications (preferred qualifications), Skills (maybe from required qualifications like analytical, communication). Could combine.
We need to avoid filler like "commensurate with experience". Not present.
We need to not include Pay/Benefits/Schedule because not mentioned.
Thus output sections: About the role, Responsibilities, Requirements, Qualifications, Skills.
We must use for each heading. Use - for any list of duties/requirements/benefits. Use
for prose.
We need to preserve all substantive information. So we need to include all bullet points.
Let's extract bullet points.
From "Essential Responsibilities" list:
- Monitor daily encounter file processing and submission activities.
- Validate encounter data prior to submission to ensure completeness and accuracy.
- Research and resolve rejected encounters from AHCA, CMS, or clearinghouses.
- Analyze encounter acceptance and rejection reports to identify trends and root causes.
- Coordinate resubmission of corrected encounter records.
- Perform reconciliation between claims adjudication systems and submitted encounter.
- Work with business users and IT to resolve data quality issues.
- Ensure encounter submissions comply with CMS, AHCA, HIPAA, and organizational. (looks truncated: "and organizational." maybe missing word but we keep as is.)
- Maintain submission schedules and regulatory deadlines.
- Assist with implementation and testing of encounter-related system enhancements.
- Document business processes, procedures, and issue resolutions.
- Support audits and regulatory requests related to encounter data.
- Participate in production support and issue resolution activities.
Then "Healthcare EDI Responsibilities:" list:
- Support And Troubleshoot HIPAA Transactions Including 837 Professional (837P), 837 Institutional (837I), 837 Dental (837D), 999 Functional Acknowledgments, TA1 Interchange Acknowledgments, 277CA Claim Acknowledgments, 835 Electronic Remittance Advice (preferred) and 275 Attachments (preferred).
That's a single sentence but could be list item.
Then "Encounter Data Responsibilities:" list:
- Validate encounter records prior to submission.
- Monitor encounter acceptance and rejection rates.
- Research front-end and back-end validation errors.
- Coordinate corrections with Claims, Configuration, and IT teams.
- Perform monthly encounter reconciliation.
- Support encounter attestation processes.
- Track encounter inventory and aging.
- Maintain encounter dashboards and operational metrics.
- Analyze recurring rejection patterns and recommend corrective actions.
- Participate in user acceptance testing (UAT) for encounter enhancements.
Then "Typical Daily Activities:" list:
- Monitor overnight encounter processing.
- Review encounter acceptance and rejection reports.
- Research failed submissions and coordinate corrections.
- Execute SQL queries for reconciliation and validation.
- Work with Claims and IT to resolve data issues.
- Track encounter inventory and aging.
- Update operational dashboards.
- Participate in production support meetings.
- Coordinate vendor and clearinghouse communications.
- Prepare regulatory submission status reports.
We need to combine all responsibilities into one list? Could separate but we can just put all under Responsibilities
. Ensure no duplication? Some items repeat (e.g., Track encounter inventory and aging appears in both Encounter Data Responsibilities and Typical Daily Activities). We should preserve all substantive information; duplicates okay? Might be okay but we could deduplicate? The instruction: Preserve ALL substantive information; do NOT invent or summarize away detail. Removing duplicates could be considered summarizing away detail? It's not inventing, but removing duplicate might be okay as it's not losing info? It's still present once. Might be okay. Safer to keep duplicates as they appear; but we can keep them as separate items; it's fine.
Now Required Qualifications:
- Bachelor's degree in Information Systems, Healthcare Administration, Computer Science, Business, or equivalent experience.
- 3–5 years of healthcare EDI or encounter management experience.
- Experience working with healthcare claims and encounter data.
- Knowledge of HIPAA X12 transaction standards.
- Strong analytical and problem-solving skills.
- Excellent written and verbal communication skills.
Preferred Qualifications:
- Experience submitting encounters to CMS, AHCA, or state Medicaid agencies.
- Experience with Edifecs, Health Suite.
- Knowledge of healthcare regulatory requirements.
Skills: maybe we can extract from required qualifications: Strong analytical and problem-solving skills; Excellent written and verbal communication skills. Also maybe knowledge of HIPAA X12 transaction standards is a skill. Could list skills separately.
But we already have Required Qualifications and Qualifications (preferred). The heading "Skills" could be used for skill-based items. We could put the skill items under Skills.
Let's decide: Use sections:
- About the role (p)
- Responsibilities (ul)
- Requirements (ul) for required qualifications? Or maybe "Requirements" for required qualifications.
- Qualifications (ul) for preferred qualifications.
- Skills (ul) for analytical, communication, etc.
But we need to ensure we don't miss any info.
Let's map:
Required Qualifications (the list) could go under Requirements.
Preferred Qualifications under Qualifications.
Skills: Strong analytical and problem-solving skills; Excellent written and verbal communication skills. Also maybe "Knowledge of HIPAA X12 transaction standards" could be skill but it's already in Required Qualifications. To avoid duplication, we could keep it under Requirements. But we already have Required Qualifications there. If we put Required Qualifications under Requirements, we include all items including analytical etc. Then Skills section may be redundant. Better to not have Skills if we already covered under Requirements. But we need to follow instruction: include a section ONLY when posting has real specific content for it. If we put Required Qualifications under Requirements, we have content. If we also add Skills, we need to have content not already covered. Could we split: Requirements = education and experience; Qualifications = preferred; Skills = analytical/communication. That would distribute content without duplication. Let's see.
Required Qualifications list includes education, years experience, experience working with claims, knowledge of HIPAA X12, analytical/problem-solving, communication. We could split:
- Requirements (education + years experience + experience working with claims + knowledge of HIPAA X12) maybe.
- Skills (analytical/problem-solving, written/verbal communication).
But the instruction: "Prefer a few substantive sections over many thin ones." So maybe better to combine Required Qualifications and Preferred Qualifications into one "Requirements" section? But we have headings: Requirements, Qualifications, Skills. We could use Requirements for required, Qualifications for preferred, and omit Skills if we already covered skills under Required Qualifications. However we need to include Skills only if there is real specific content for it. There is content (analytical, communication). But we could also include them under Requirements; but then Skills would be empty or filler. Better to put them under Skills and keep Requirements for education/experience etc. Let's do that.
Thus:
Requirements: education, years experience, experience working with claims, knowledge of HIPAA X12 transaction standards.
Qualifications (preferred): experience submitting encounters to CMS/AHCA/state Medicaid, experience with Edifecs/Health Suite, knowledge of healthcare regulatory requirements.
Skills: Strong analytical and problem-solving skills; Excellent written and verbal communication skills.
Now we need to ensure we haven't lost any info: we omitted "Experience working with healthcare claims and encounter data" from Required Qualifications (we included under Requirements). Good. We omitted "Knowledge of HIPAA X12 transaction standards" (included). Good.
Now we need to format.
Let's craft HTML:
About the role
The EDI Encounter Specialist is responsible for the administration, monitoring, validation, and support of healthcare encounter data submitted to state (AHCA) and CMS, as well as those received from clearinghouses and business partners. This position ensures encounter data is complete, accurate, compliant, and submitted within required regulatory timeframes. The specialist works closely with Claims, IT, Compliance, Finance, Vendor Management, and external vendors to identify, research, and resolve encounter submission issues while maintaining compliance with CMS, AHCA, HIPAA, and ANSI X12 standards.
Responsibilities
- Monitor daily encounter file processing and submission activities.
- Validate encounter data prior to submission to ensure completeness and accuracy.
- Research and resolve rejected encounters from AHCA, CMS, or clearinghouses.
- Analyze encounter acceptance and rejection reports to identify trends and root causes.
- Coordinate resubmission of corrected encounter records.
- Perform reconciliation between claims adjudication systems and submitted encounter.
- Work with business users and IT to resolve data quality issues.
- Ensure encounter submissions comply with CMS, AHCA, HIPAA, and organizational.
- Maintain submission schedules and regulatory deadlines.
- Assist with implementation and testing of encounter-related system enhancements.
- Document business processes, procedures, and issue resolutions.
- Support audits and regulatory requests related to encounter data.
- Participate in production support and issue resolution activities.
- Support And Troubleshoot HIPAA Transactions Including 837 Professional (837P), 837 Institutional (837I), 837 Dental (837D), 999 Functional Acknowledgments, TA1 Interchange Acknowledgments, 277CA Claim Acknowledgments, 835 Electronic Remittance Advice (preferred) and 275 Attachments (preferred).
- Validate encounter records prior to submission.
- Monitor encounter acceptance and rejection rates.
- Research front-end and back-end validation errors.
- Coordinate corrections with Claims, Configuration, and IT teams.
- Perform monthly encounter reconciliation.
- Support encounter attestation processes.
- Track encounter inventory and aging.
- Maintain encounter dashboards and operational metrics.
- Analyze recurring rejection patterns and recommend corrective actions.
- Participate in user acceptance testing (UAT) for encounter enhancements.
- Monitor overnight encounter processing.
- Review encounter acceptance and rejection reports.
- Research failed submissions and coordinate corrections.
- Execute
- for any list of duties/requirements/benefits. Use
for prose. We need to preserve all substantive information. So we need to include all bullet points. Let's extract bullet points. From "Essential Responsibilities" list: - Monitor daily encounter file processing and submission activities. - Validate encounter data prior to submission to ensure completeness and accuracy. - Research and resolve rejected encounters from AHCA, CMS, or clearinghouses. - Analyze encounter acceptance and rejection reports to identify trends and root causes. - Coordinate resubmission of corrected encounter records. - Perform reconciliation between claims adjudication systems and submitted encounter. - Work with business users and IT to resolve data quality issues. - Ensure encounter submissions comply with CMS, AHCA, HIPAA, and organizational. (looks truncated: "and organizational." maybe missing word but we keep as is.) - Maintain submission schedules and regulatory deadlines. - Assist with implementation and testing of encounter-related system enhancements. - Document business processes, procedures, and issue resolutions. - Support audits and regulatory requests related to encounter data. - Participate in production support and issue resolution activities. Then "Healthcare EDI Responsibilities:" list: - Support And Troubleshoot HIPAA Transactions Including 837 Professional (837P), 837 Institutional (837I), 837 Dental (837D), 999 Functional Acknowledgments, TA1 Interchange Acknowledgments, 277CA Claim Acknowledgments, 835 Electronic Remittance Advice (preferred) and 275 Attachments (preferred). That's a single sentence but could be list item. Then "Encounter Data Responsibilities:" list: - Validate encounter records prior to submission. - Monitor encounter acceptance and rejection rates. - Research front-end and back-end validation errors. - Coordinate corrections with Claims, Configuration, and IT teams. - Perform monthly encounter reconciliation. - Support encounter attestation processes. - Track encounter inventory and aging. - Maintain encounter dashboards and operational metrics. - Analyze recurring rejection patterns and recommend corrective actions. - Participate in user acceptance testing (UAT) for encounter enhancements. Then "Typical Daily Activities:" list: - Monitor overnight encounter processing. - Review encounter acceptance and rejection reports. - Research failed submissions and coordinate corrections. - Execute SQL queries for reconciliation and validation. - Work with Claims and IT to resolve data issues. - Track encounter inventory and aging. - Update operational dashboards. - Participate in production support meetings. - Coordinate vendor and clearinghouse communications. - Prepare regulatory submission status reports. We need to combine all responsibilities into one list? Could separate but we can just put all under Responsibilities
- . Ensure no duplication? Some items repeat (e.g., Track encounter inventory and aging appears in both Encounter Data Responsibilities and Typical Daily Activities). We should preserve all substantive information; duplicates okay? Might be okay but we could deduplicate? The instruction: Preserve ALL substantive information; do NOT invent or summarize away detail. Removing duplicates could be considered summarizing away detail? It's not inventing, but removing duplicate might be okay as it's not losing info? It's still present once. Might be okay. Safer to keep duplicates as they appear; but we can keep them as separate items; it's fine.
Now Required Qualifications:
- Bachelor's degree in Information Systems, Healthcare Administration, Computer Science, Business, or equivalent experience.
- 3–5 years of healthcare EDI or encounter management experience.
- Experience working with healthcare claims and encounter data.
- Knowledge of HIPAA X12 transaction standards.
- Strong analytical and problem-solving skills.
- Excellent written and verbal communication skills.
Preferred Qualifications:
- Experience submitting encounters to CMS, AHCA, or state Medicaid agencies.
- Experience with Edifecs, Health Suite.
- Knowledge of healthcare regulatory requirements.
Skills: maybe we can extract from required qualifications: Strong analytical and problem-solving skills; Excellent written and verbal communication skills. Also maybe knowledge of HIPAA X12 transaction standards is a skill. Could list skills separately.
But we already have Required Qualifications and Qualifications (preferred). The heading "Skills" could be used for skill-based items. We could put the skill items under Skills.
Let's decide: Use sections:
- About the role (p)
- Responsibilities (ul)
- Requirements (ul) for required qualifications? Or maybe "Requirements" for required qualifications.
- Qualifications (ul) for preferred qualifications.
- Skills (ul) for analytical, communication, etc.
But we need to ensure we don't miss any info.
Let's map:
Required Qualifications (the list) could go under Requirements.
Preferred Qualifications under Qualifications.
Skills: Strong analytical and problem-solving skills; Excellent written and verbal communication skills. Also maybe "Knowledge of HIPAA X12 transaction standards" could be skill but it's already in Required Qualifications. To avoid duplication, we could keep it under Requirements. But we already have Required Qualifications there. If we put Required Qualifications under Requirements, we include all items including analytical etc. Then Skills section may be redundant. Better to not have Skills if we already covered under Requirements. But we need to follow instruction: include a section ONLY when posting has real specific content for it. If we put Required Qualifications under Requirements, we have content. If we also add Skills, we need to have content not already covered. Could we split: Requirements = education and experience; Qualifications = preferred; Skills = analytical/communication. That would distribute content without duplication. Let's see.
Required Qualifications list includes education, years experience, experience working with claims, knowledge of HIPAA X12, analytical/problem-solving, communication. We could split:
- Requirements (education + years experience + experience working with claims + knowledge of HIPAA X12) maybe.
- Skills (analytical/problem-solving, written/verbal communication).
But the instruction: "Prefer a few substantive sections over many thin ones." So maybe better to combine Required Qualifications and Preferred Qualifications into one "Requirements" section? But we have headings: Requirements, Qualifications, Skills. We could use Requirements for required, Qualifications for preferred, and omit Skills if we already covered skills under Required Qualifications. However we need to include Skills only if there is real specific content for it. There is content (analytical, communication). But we could also include them under Requirements; but then Skills would be empty or filler. Better to put them under Skills and keep Requirements for education/experience etc. Let's do that.
Thus:
Requirements: education, years experience, experience working with claims, knowledge of HIPAA X12 transaction standards.
Qualifications (preferred): experience submitting encounters to CMS/AHCA/state Medicaid, experience with Edifecs/Health Suite, knowledge of healthcare regulatory requirements.
Skills: Strong analytical and problem-solving skills; Excellent written and verbal communication skills.
Now we need to ensure we haven't lost any info: we omitted "Experience working with healthcare claims and encounter data" from Required Qualifications (we included under Requirements). Good. We omitted "Knowledge of HIPAA X12 transaction standards" (included). Good.
Now we need to format.
Let's craft HTML:
- Monitor daily encounter file processing and submission activities.
- Validate encounter data prior to submission to ensure completeness and accuracy.
- Research and resolve rejected encounters from AHCA, CMS, or clearinghouses.
- Analyze encounter acceptance and rejection reports to identify trends and root causes.
- Coordinate resubmission of corrected encounter records.
- Perform reconciliation between claims adjudication systems and submitted encounter.
- Work with business users and IT to resolve data quality issues.
- Ensure encounter submissions comply with CMS, AHCA, HIPAA, and organizational.
- Maintain submission schedules and regulatory deadlines.
- Assist with implementation and testing of encounter-related system enhancements.
- Document business processes, procedures, and issue resolutions.
- Support audits and regulatory requests related to encounter data.
- Participate in production support and issue resolution activities.
- Support And Troubleshoot HIPAA Transactions Including 837 Professional (837P), 837 Institutional (837I), 837 Dental (837D), 999 Functional Acknowledgments, TA1 Interchange Acknowledgments, 277CA Claim Acknowledgments, 835 Electronic Remittance Advice (preferred) and 275 Attachments (preferred).
- Validate encounter records prior to submission.
- Monitor encounter acceptance and rejection rates.
- Research front-end and back-end validation errors.
- Coordinate corrections with Claims, Configuration, and IT teams.
- Perform monthly encounter reconciliation.
- Support encounter attestation processes.
- Track encounter inventory and aging.
- Maintain encounter dashboards and operational metrics.
- Analyze recurring rejection patterns and recommend corrective actions.
- Participate in user acceptance testing (UAT) for encounter enhancements.
- Monitor overnight encounter processing.
- Review encounter acceptance and rejection reports.
- Research failed submissions and coordinate corrections.
- Execute
About the role
The EDI Encounter Specialist is responsible for the administration, monitoring, validation, and support of healthcare encounter data submitted to state (AHCA) and CMS, as well as those received from clearinghouses and business partners. This position ensures encounter data is complete, accurate, compliant, and submitted within required regulatory timeframes. The specialist works closely with Claims, IT, Compliance, Finance, Vendor Management, and external vendors to identify, research, and resolve encounter submission issues while maintaining compliance with CMS, AHCA, HIPAA, and ANSI X12 standards.
Responsibilities