The EDI Claims Processing Coordinator I is responsible to perform the data validation and interchange between EZCAP and EZ-EDI applications, including monitoring the daily auto-processing and auto-posting activities of EDI files, correcting identified errors discrepancies, providing timely acknowledgement per AB1455 requirements. This position will also assist in health plan audits and other special projects as needed.
The EDI Claims Processing Coordinator I should have excellent analytical and problem-solving skills; be able to juggle multiple projects to ensure follow-through, and work in a detail-oriented manner.
ESSENTIAL JOB FUNCTIONS:
• Responsible for monitoring the daily automatic in-load, validation, and posting activities in EZ-EDI application for the HIPPA 837 EDI files
received through the NEMS SFTP.
• Traces error claims identified by the EZ-EDI application during the automatic in-load process; identifies and corrects errors, revalidates
and reposts the corrected records into EZCAP.
• Reconciles in-loaded records with submitted records to ensure data accuracy.
• Generates 277CA/999/997 Claims Acknowledgement report for Trading Partners after each EDI file is posted into EZCAP successfully.
• Communicates with Trading Partners about data errors and files “rejects” information,
• Follows through with resubmission activities.
• Communicates with database team members to update new/changed provider records and service codes in EZCAP as seen in the
submitted EDI files.
• Catalogs and maintains an EDI processing log for each individual Trading Partner who submits an EDI file, to record and reconcile
validation errors for each submitted file.
• Provides information in response to the requests from EDI submitters, patients, physicians, insurance companies or co-workers as
• Assists in Health Plan and/or DHCS audits and other special projects as needed.
• Performs other job duties as required by manager/supervisor.
• Bachelors Degree in Systems Analysis, Computer Programming, or other relevant area of study or Bachelors Degree in General Education
and one year’ experience in health care data exchange or equivalent combination of education and experience.
• One (1) years’ experience in health insurance claims processing/examination;
• One (1) years’ experience in handling health care Electronic Data Interchange activities in HIPAA formatted files;
• Must have strong analytical and problem solving skills.
• Strong written and verbal communication skill, with employees at all level within NEMS.
• Demonstrated ability to use Microsoft Access, Excel, or Crystal Reports as troubleshooting tools;
• Ability to self-manage in a detail oriented environment.
• Good organization and prioritization skills; outstanding time management.
• Ability to reliably and consistently deliver quality work product on target dates.
• Knowledge of healthcare standard code sets and claim forms preferred.
• Experience with computer programming a plus.
• Knowledge of State/Federal healthcare compliance requirements (HIPAA, AB1455) and DHCS/Medi-Cal guidelines a plus.
• Must be able to fluently speak, read and write English.
• Fluency in other languages are an asset.
This is an FLSA NON-exempt position.
This is not an OSHA high-risk position.
NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).