Job Description

Summary

The Specialist I, EDI Eligibility is responsible for retrieving, processing, validating, and posting electronic eligibility data files into MPM’s core system, EZ-CAP. Under the direction of the Supervisor, EDI Eligibility, the Specialist I, EDI Eligibility will ensure all files are processed timely and meet compliance regulations to maintain eligibility data integrity.

Duties and Responsibilities:

• Develop an understanding of electronic data file(s) definitions, HIPPA standard ANSI 834 formats, and other Health Plan proprietary format(s) for eligibility data files.
• Use Eligibility Manager (EM) & Eligibility Web Scraper (EWS) to clean up / process / and create EPF data files to load into EZ-NET for Medi-Cal, Commercial, and some select Medicare lines of business within 48 hours of receiving the eligibility data file(s).
• Ability to identify issues and escalate to team leadership when necessary.
• Develop an understanding of the EZ-CAP core system to manually add or edit member records and document manual changes according to standard operating procedure.
• Other duties as assigned by team leadership.

Minimum Job Requirements:

• High School diploma or GED equivalent or 1-year of equivalent experience in a similar role and/or experience with managed healthcare eligibility data and requirements.
• Experience working with Eligibility Manager & EZ-CAP/EZ-NET preferred.
• Experience working with Smartsheet preferred.
• Working knowledge of MS Office Suite of products (Word, Excel, Outlook, One Note)
• Understanding of managed healthcare business operations preferred.

Skills and Abilities:

• Effective organizational, analytical, and oral/written communication skills.
• Effective attention to detail.
• Eagerness to contribute to team-oriented environment.
• Understanding and commitment to all the MPM Core Values.
• Commitment to fully understand and adhere to all policies and procedures.

Salary Range:

• $24 – $26 hourly

Job Tags

Similar Jobs