An Employer in the Mason, OH area is seeking a Sr. EDI Manager for a hybrid three day onsite contract to hire opportunity. The ideal candidate will play a critical role within the Business Data Solutions team to maintain and implement Medicaid encounter feeds. This role will be the primary resource implementing new client and/or state outbound transactions. You will develop requirements based on stakeholder meetings and interpretation of Companion Guides. You will identify, recommend and implement process improvements in support of the EDI system based on observation, monitoring and external inquiries regarding EDI issues. They will also be responsible for researching and analyzing encounter edits or rejections for Medicaid clients and work with internal/external teams to resolve. They will work to improve overall encounter, member and provider data quality. As well as tracking encounter submission quality and timeliness.
Maintain compliance to all company and regulatory policies
Provide support during and after implementation for HIPAA claims-based EDI transactions
Respond to inquiries regarding EDI issues with encounter claims and trading partner activities
Ensures all outbound 837 transactions return appropriate responses (999, 277CA, custom)
Develop standard and custom testing plans to ensure compliance with requirements
Develop and execute test scripts related to EDI transactions
Conducts QA and testing on EDI applications
Management of catalog of EDI Companion Guides such as 837, 999, 277CA, 835
Maintain detailed documentation and process flow of all EDI processes
Research and analyze Encounter Edits or Rejections to identify trends and root cause
Collaborate with other departments to research, identify and correct data errors to minimize ongoing rejection risk
We are a company committed to creating inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity employer that believes everyone matters. Qualified candidates will receive consideration for employment opportunities without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, disability, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to
HR@insightglobal.com. The EEOC "Know Your Rights" Poster is available
here.
To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy:
https://insightglobal.com/workforce-privacy-policy/ .
Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.