Simplify Logo

Full-Time

Claims EDI Coordinator

Posted on 6/18/2024

Gravie

Gravie

201-500 employees

Offers no-deductible health plans for employers

Financial Services

Entry

Minneapolis, MN, USA

Category
Data Management
Data Engineering
Data & Analytics
Required Skills
SQL
Requirements
  • 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
Responsibilities
  • Oversee and monitor all inbound and outbound EDI transfers within our claims management system
  • 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
  • Maintain EDI technical standards, identify integration needs, and improve the efficiency of 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
  • 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
  • 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

Gravie offers a compelling workplace given its significant role in transforming healthcare plans for small and midsize employers by eliminating common financial burdens such as deductibles and copays. The company stands out in its market segment by embracing technology that allows coverage of essential healthcare services at no extra cost, thereby pioneering a model that significantly eases the health management for employers and their teams. This cultural commitment to alleviating healthcare challenges and the practical approach in application not only positions it as a leader in its sector but also enriches its internal work environment through a clear, positive mission that directly benefits society.

Company Stage

Series E

Total Funding

$342.6M

Headquarters

Minneapolis, Minnesota

Founded

2013

Growth & Insights
Headcount

6 month growth

3%

1 year growth

32%

2 year growth

82%
INACTIVE