Senior EDI Coordinator

🔥 14 hours ago

🍂 Massachusetts – Remote

🍂 Massachusetts – Remote

⏰ Full Time

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Fallon Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1977

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

Fallon Health is a health insurance provider that simplifies health coverage for individuals, families, and Medicare recipients. They offer a variety of health plans including Medicare and MassHealth, along with resources for members such as fitness reimbursement programs and member portals to track deductibles and manage claims. Fallon Health focuses on providing accessible healthcare options and support for caregivers, ensuring comprehensive care for their members.

📋 Description

• Oversee the company’s EDI process • Track incoming and outgoing EDI files • Monitor and research unsuccessful transmissions • Recognize issue patterns and contact appropriate parties for resolution • Handle provider concerns regarding submission discrepancies • Lead efforts to increase contracted providers using electronic submission • Train and develop EDI staff and other department members as needed • Document new EDI procedures, policies, and processes • Liaise between IT, Configuration, EDI Coordinators, internal departments, external customers, and contracted providers • Implement HIPAA transaction sets across the company, including 270/271, 276/277, 278, 820, 835, 837I, and 837P • Represent the EDI team in internal and external customer meetings • Set up security for online tools, including Provider Tools and Employer Tools • Run KEA scripting software for Weight Watchers claims • Provide weekly updates on Trading Partners in testing phases • Test Edifecs and QNXT upgrades or changes related to electronic submission • Test new and updated technology applications against current EDI logic and communicate results • Increase provider electronic claim submission and EDI performance measures • Increase the auto-adjudication rate of EDI claims • Manage communications concerning submission issues requiring troubleshooting • Administer relationships with clearinghouse vendors • Track EDI file names, dates, claim counts, fatal edits, and file processing statuses • Seek quality improvements for the EDI process • Oversee and monitor reconciliation of EDI claim submissions • Work independently under minimal supervision while meeting deadlines

🎯 Requirements

• Bachelor’s Degree required • Master’s degree or foreign equivalent in Electrical/Electronic Engineering, Electrical Power Systems, Computer Science, Engineering, or a related field preferred • Two (2) years of experience as a Software Engineer or related occupation preferred for candidates with the preferred master’s degree • If the education major is other than preferred: 4–7 years’ experience in the operational side of a Managed Care Organization, or 2+ years of experience with the preferred degree • QNXT experience required • Extremely PC savvy • Strong knowledge of MS Office required • Internet experience required • BizTalk experience required • Strong project leadership skills • Proven verbal and written communication skills • EDI experience required, including regression testing and SNIP level validation • Basic SQL skills required for troubleshooting and validating issues

🏖️ Benefits

• Equal employment opportunity and anti-discrimination protections • Possible remote work arrangement (as indicated in the job title)