Reporting to the Manager, HIT Operations, the Supervisor, EDI Claims is responsible for the supervision of all day-to-day activities of the EDI Claims team, including but not limited to providing direction; monitoring teammate (TM) performance; and improvement of workflows and processes. The EDI Claims team is responsible for acknowledging, processing, and ensuring that all claims received are posted timely and accurately in the EZ-CAP system. 

Duties and Responsibilities

•         Manage and provide direction to ensure all electronics claims files are processed timely.

•         Ensure all files are received according to expected timelines and escalate issues when needed.

•         Provide support to resolve processing or data issues and escalate issues when needed.

•         Support the programming of required logic and implementation of tools, systems, and applications used for the loading of claims into EZ-CAP.

•         Develop and maintain productivity and reconciliation reports, including but not limited to inbound electronic claims volume and data accuracy reports.

•         Facilitate the development, review, and revision of team policies, procedures, and workflow diagrams.

•         Collaborate effectively with internal and external stakeholders to ensure the smooth execution of team functions, including but not limited to the Claims Operations department.

•         Collaborate with HIT leadership to develop benchmark measures that evaluate work productivity and quality.

•         Review and analyze the effectiveness and efficiency of existing processes and develop strategies for improvement.

•         Ensure that complex claims EDI issues are resolved within established guidelines.

•         Serve as technical and informational resource for all TMs, facilitating TM training and mentorship.

•         Evaluate work assignments in support of efficient file processing.

•         Respond to escalated questions and/or issues brought up by the team.

•         Monitor and manage TM time, overtime, and scheduling.

•         Develop new EDI solutions for business operations as needed to remain compliant with regulatory requirements.

•         Other job responsibilities as assigned.

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Minimum Job Requirements

•         Strong knowledge of HIPAA ANSI 834, 270, and 271 format(s) and Health Plan proprietary formats.

•         Bachelor’s degree or 4+ years equivalent work experience in a similar role

•         Ability to navigate EZ-CAP, Tableau, and Smartsheet

•         Proficiency in Microsoft Office (Word, Excel, PowerPoint, Visio, OneNote)

Skill and Abilities

•         Strong organizational skills, with the ability to manage several projects and priorities at the same time.

•         Ability to work effectively with all levels of the organizations and stakeholders, including health plans and clients.

•         Positive attitude and flexible, a must.

•         The ability to take initiative while remaining open to the ideas of others.

•         Strong communication, analytical, coaching/mentoring, and team building skills.

•         Ability to troubleshoot problems and recommend, develop, and implement effective improvements.

•         Ability to use sound judgment in completing tasks and to seek guidance when needed.