EDI Analyst - Durham
Core
Frontline telephone support for EDI batch and real-time trading partners and secure web portal users, investigating issues and resolving electronic claims and eligibility problems.
Role type
EDI Technical Support Specialist
Builds
Support for electronic transaction and connectivity issues, web portal functionality, and access security protocols
Domain
Healthcare / Health Insurance / EDI
Deliverable
client delivery
Required skills
EDI helpdesk operations, electronic claims processing, eligibility verification, claim status tracking, authorizations, remittance processes, root cause analysis, risk mitigation, HIPAA compliance, BCBSA regulations
Preferred skills
Advanced degree, 5+ years experience in absence of degree
Technologies
Security Web
Responsibilities
Deliver frontline telephone support for EDI batch and real-time trading partners and secure web portal users; Investigate user issues, identify root causes, and work toward effective resolutions; Respond to helpdesk questions on procedures and protocols for electronic claims, eligibility, claim status, authorizations, and remittance processes; Act as the first point of resolution for electronic transaction and connectivity issues; Research complex application failures using multiple resources and determine severity and escalation paths; Establish mitigation risk and communicate findings to management and IT stakeholders; Train Blue e users on web portal functionality and administrators on access security protocols; Assist with updates and revisions to provider materials; Maintain accurate, complete documentation in the inquiry tracking database; Monitor EDI production systems using reports and dashboards to review compliance, error rates, and claim balancing; Support adherence to state, federal, HIPAA, and BCBSA regulations and recommend process improvements when needed
