Job Description

Job Description

Summary

The Processor, EDI Claims is responsible for retrieving, processing, validating, and posting electronic claim data files into MPM’s core system, EZ-CAP®. Reporting to the Supervisor, EDI Claims, the Processor, EDI Claims teammate will ensure all files are processed timely and meet compliance regulations.

Duties and Responsibilities

· Develop an understanding of electronic data file(s) definitions, HIPAA standard ANSI 837 formats, and other Health Plan proprietary format(s) for claim data files.

· Develop an understanding of the EZ-CAP core system to navigate through claims and provider profiles.

· Use Bowman to clean up / process / and create EPF data files to load into EZ-NET®.

· Document, track, and reconcile all assigned or re-assigned files processed from beginning to end.

· Fix rejects/post errors to ensure 100% of claim records in each batch are documented and posted.

• Attend organizational meetings as required.

· Other duties as assigned by team leadership.

Minimum Job Requirements

· High School diploma or GED equivalent or 1 year of equivalent experience in a similar role and/or experience with managed healthcare eligibility data and requirements.

· Experience working with EZ-CAP/EZ-NET preferred.

· Experience working with Smartsheet preferred.

· Working knowledge of MS Office Suite of products (Word, Excel, Outlook, One Note)

· Understanding of managed healthcare business operations preferred.

Skill and Abilities

· Effective organizational, analytical, and oral/written communication skills.

· Effective attention to detail.

· Eagerness to contribute to a team-oriented environment.

· Understanding and commitment to all the MPM Core Values.

· Commitment to fully understand and adhere to all policies and procedures.