EDI Eligibility Specialist jobs in United States
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VIVA HEALTH · 1 month ago

EDI Eligibility Specialist

VIVA HEALTH is a health maintenance organization that provides quality, accessible health care and is part of the University of Alabama at Birmingham (UAB) Health System. The EDI Eligibility Specialist will develop and maintain eligibility EDI programs and assist with the maintenance and execution of processes surrounding eligibility business requirements.

Health CareInsurance
Hiring Manager
Pete Bond
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Responsibilities

Carry out the end-to-end steps to receive and transform data to be loaded into VIVA HEALTH’S systems
Work closely with the Finance, Operations, and Medicare departments to support their respective business functions surrounding enrollment
Work with third party vendors to analyze and setup appropriate processes for eligibility and claims data feeds from VIVA HEALTH’S systems
Work with the Compliance/Legal departments to ensure proper documentation is in place before data feeds are setup

Qualification

Database technologyMS AccessANSI 5010 834MS SQLHealth Plan experienceHIPAA knowledgeACA knowledgeProcess ownershipMicrosoft certificationsPMI certificationsInterpersonal skillsVerbal communicationWritten communicationAttention to detail

Required

Bachelor's Degree or equivalent work experience
1- 3 years' experience with database technology/process management
Demonstrated experience with successful ownership of processes
Excellent interpersonal skills for frequent interaction with users, managers, and vendors
Excellent verbal and written communications skills
Excellent attention to detail and accuracy
Knowledge of MS Access

Preferred

3 – 5 years' experience with database technology/process management
Experience with MS SQL
Health Plan experience
Microsoft and/or PMI certifications
Understanding of the relationship between health plan eligibility and premium accounting
Knowledge of ANSI 5010 834 file formats
Knowledge of HIPAA and ACA

Benefits

Comprehensive Health, Vision, and Dental Coverage
401(k) Savings Plan with company match and immediate vesting
Paid Time Off (PTO)
9 Paid Holidays annually plus a Floating Holiday to use as you choose
Tuition Assistance
Flexible Spending Accounts
Healthcare Reimbursement Account
Paid Parental Leave
Community Service Time Off
Life Insurance and Disability Coverage
Employee Wellness Program
Training and Development Programs to develop new skills and reach career goals
Employee Assistance Program

Company

VIVA HEALTH

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VIVA HEALTH is the preferred healthcare provider which provides Health Insurance, Medicare, Medicaid and Healthcare.

Funding

Current Stage
Late Stage

Leadership Team

C
Cardwell Feagin
COO
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