Job Description
Job Description
Seeking an EDI expert in order to maintain and advance its health insurance claims processing system, ACAPS.
The EDI Expert is responsible for maintaining the life cycle of claims as they arrive from health providers at , are loaded into our database, are adjudicated based on state and national pricing standards, and as adjudication messages are generated and sent back to the originating provider. This position will work with the project manager, software developers, business analysts, and functional team members on the project activities.
Essential Duties / Responsibilities:
Review update all documentation related to claims processing and EDI transactions
Identify incompletely documented claims processing and EDI processes, and document them
Work with development team as a SME as s ACAPS system is rewritten in .Net
Act as liaison between OTC team and the Childrens program area on claims processing issues
Working with technical and functional staff on detailed business requirements, understanding business processes and technology, agency standards, federal and state policies to align with projects goals.
Write technical specifications based on conceptual design and stated business requirements.
Test new and existing systems
Ensure accurate and appropriate file exchanges with external trading partners and resolve EDI data transmission conflicts.
Provide helpdesk level support for EDI claim transactions.
Provide support to healthcare providers who interact with s CSHCS system
Assist in onboarding new providers
Assist in onboarding new clearinghouses
Ability to work independently with less guidance and work with ISDH externals partners as needed.