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Claims EDI Coordinator

Gravie

Gravie

Minneapolis, MN, USA
Posted on Thursday, May 9, 2024
Hi, we’re Gravie, and we are building the health plan of the future. For the past few decades, the health insurance industry has evolved to serve the needs of employers, insurance companies, brokers, and (sometimes) doctors and hospitals. The needs of the consumer, however, have largely been left out of the equation. We’re changing that. We are rebuilding the entire health insurance stack, with the consumer as the central focus. Our goal is to create a health plan that people can love.
At Gravie, you’ll get to do things every single day to support making health benefits easy to understand and simple to navigate. You’ll work at a startup that has demonstrated amazing growth and our future is only getting brighter. We're past the risky early stage, but have only put a dent in the incredible innovations to come. And you’ll join a hugely talented and passionate team. After all, you are our competitive advantage. Our industry-changing products and services couldn’t exist without our talented people thinking about how to make healthcare benefits better every single day. It takes unique people on diverse teams to deliver the kinds of results we deliver. We encourage you to be your authentic self - we like you that way.
A Little More About The Role:
The Claims EDI Coordinator oversees the internal production and support process of the adjudication and reporting of medical and Rx claims. They will work closely with other departments to proactively research concerns and resolve issues. The person will handle EDI file management for all aspects of the claims administration system, queries, reporting, process enhancement, and play a key role in making sure we’re serving our clients to the Gravie standard.
You Will:
· Oversee and monitor all inbound and outbound EDI transfers within our claims management system including claims, eligibility, and financial transactions.
· Support the day-to-day operations of EDI including identifying and resolving technical issues.
· Manage EDI projects and ensure compliance with technical standards and requirements.
· Analyze business needs and design and implement efficient data exchanges internally and with external vendors and partners.
· Lead innovation by improving processes and procedures to ensure compliance with regulatory requirements including HIPAA standards for PHI protection and transmission.
· Collaborate with cross-functional teams to support operations and organizational needs.
· Demonstrate commitment to our core competencies of being authentic, curious, creative, empathetic and outcome oriented.
Technical Support
· Maintain EDI technical standards, identify integration needs, and improve the efficiency of our EDI communications and transactions.
· Run/schedule/monitor EDI jobs from our claims management system, Javelina.
· Identify, track, & ensure resolution of all technical or processing related issues across the Javelina system.
· Lead the execution of the strategic initiatives to meet department and company goals.
· Work with the Claims Team to resolve technical issues and/or system constraints ensuring claim flow in accordance with performance KPIs.
Process Improvement
· Identify client needs and demands and contribute to the continual improvement of the operations team.
· Address deficiencies and error trends in order to resolve matters both internal and external.
· Recognize and facilitate Process Improvement efforts as opportunity presents.
· Work cross-departmentally to improve and streamline processes and procedures.
Quality Assurance
· Maintain HIPAA/PII security standards to ensure data integrity across all EDI operations.
· Ensure compliance with service standards.
· Develop and execute plans to meet established goals.
· Provide continuous feedback to strengthen and optimize quality performance.
· Develop or improve current internal processes to improve overall quality.
· Identify and communicate EDI related errors to key stakeholders and assist with resolution.
You Bring:
· Associate degree or equivalent
· Experience in processing / outsourcing services for payor or self-insured groups
· In-depth working knowledge of ANSI X12 EDI files such as 270/271, 276/277, 834, 837, 999
· Experience in identifying/repairing/solving technical issues with EDI transactions
· Experience with SQL and relational databases
· Excellent verbal and written skills and decision-making abilities
· Able to organize, problem-solve and prioritize multiple tasks
· Positive, professional attitude
· Ability to work independently and within a team environment
· Ability to respect and maintain confidentiality and HIPAA guidelines
· Working knowledge of computer-based word processing and spreadsheet packages; proficiency with MS Office products
Extra Credit:
· TPA experience
· Javelina experience/administration
· Claims processing and claims payment experience
· Knowledge of medical terminology
· Improving and increasing technical knowledge through training and education
· Previous startup company experience
· Previous experience having worked at or with an Electronic Clearing House
· EDI certifications
Competitive pay is standard. Our unique benefits program is the gravy, i.e., the special sauce that sets our compensation package apart. In addition to standard benefits, Gravie’s package includes alternative medicine coverage, flexible PTO, up to 16 weeks paid parental leave, paid holidays, cell phone reimbursement, education reimbursement, and 1 week of paid paw-ternity leave just to name a few.