EDI Admin I/II
About The Position
Under the direction of assigned management, the Electronic Data Interface (EDI) Administrator provides quality assurance during onboarding for electronic submissions, including testing and ongoing production support. The role analyzes issues and provides feedback for continuous process improvement to maximize customer electronic transaction submissions. At higher levels, the administrator performs quality assurance for more complex interfaces, including Secure File Transfer Protocol (SFTP) facilitation and testing. The position has three classification levels with increasing independence, complexity, responsibility, and decision-making. Level I supports file movement and automation, conducts basic testing, monitors electronic transaction processing, investigates and documents production issues, and escalates potential business impacts. Level II adds participation in onboarding and corporate X12 testing, implementation and maintenance of transaction feeds, procedural documentation, project support, and coordination with trading partners. Level III adds independent certification testing and test-data creation, project planning, escalation support, vendor and group communications, and mentoring of lower-level administrators. The role requires prolonged periods sitting and/or standing at a workstation while working on a computer. Travel across the Health Plan service region for meetings or training may be needed. Compensation is listed as $23.75–$37.70 per hour for Level I and $26.90–$43.02 per hour for Level II. The posting notes that remote work may be available on a case-by-case basis.
Requirements
- At least two years of customer service, electronic transaction support, or IT help desk related experience for Level I.
- Ability to identify root causes of processing issues and determine sources for solutions and opportunities.
- Strong communication and organizational skills, and flexibility in meeting demands.
- Familiarity with using a PC, Windows, Word, Excel, and email.
- At least five years of customer service, electronic transaction support, or IT help desk related experience for Level II.
- Experience with GUIs and electronic connectivity systems or applications for Level II.
- Ability to triage and coordinate first-level resolution of EDI production issues across departments for Level II.
- At least seven years of electronic transaction support or IT help desk related experience for Level III.
- At least one year of experience independently resolving EDI production issues for Level III.
- Expertise with GUIs and electronic connectivity systems or applications for Level III.
- Ability to analyze claims routing and inbound and outbound transaction file specifications for Level III.
Nice To Haves
- Associate degree in business, information systems, or computer science.
- Familiarity with GUIs and electronic connectivity systems or applications for Level I.
- Understanding of claims routing and inbound and outbound transaction file specifications for Level I.
Responsibilities
- Support Business and IT teams with file movement and automation tasks, including manually loading files through SFTP when automation is unavailable.
- Conduct basic testing of electronic submissions under guidance.
- Monitor daily electronic transaction processing and take appropriate action to reduce or eliminate issues.
- Research production problems and issues within EDI production Service Level Agreements.
- Analyze applications to identify, research, and resolve problems; document issues in tracking software and inform management of problems or potential business impacts.
- Research web and vendor inquiries as required.
- Participate in testing phases for onboarding and corporate X12 projects, including regression and Council for Affordable Quality Healthcare testing and onboarding (Level II).
- Understand ANSI X12 transactions and mapping documentation to implement new file feeds or update existing transactions with vendors, carriers, or clients (Level II).
- Document and update departmental e-commerce procedures and create flow charts, reports, and training documentation for problem-solving and projects (Level II).
- Assist with Service Requests and project implementation activities, and coordinate resolution efforts for trading partners, including dial-up and file-transfer protocols (Level II).
- Conduct certification testing for onboarding new broker or group formats, mandates, or communications channels (Level III).
- Translate high-level requirements into test data files and deliver and implement work plans for large projects (Level III).
- Serve as an escalation analyst for EDI production problems involving enrollment, gateway defects, web issues, or vendor trouble tickets (Level III).
- Assist with testing new vendors or carriers and communicate with vendors and groups about business rules, onboarding, and testing results (Level III).
- Represent team management at senior-level meetings when needed, assist team members, and mentor lower-level Administrators (Level III).
- Support the Lifetime Healthcare Companies’ mission and values, adhere to the Corporate Code of Conduct, and maintain member privacy in accordance with corporate policies and procedures.
- Maintain regular and reliable attendance and perform other functions assigned by management.
Benefits
- Group health insurance may be available as part of the total rewards package.
- Dental insurance may be available as part of the total rewards package.
- Retirement plan may be available as part of the total rewards package.
- Wellness program may be available as part of the total rewards package.
- Paid time away from work may be available as part of the total rewards package.
- Paid holidays may be available as part of the total rewards package.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
