EDI Specialist

Company: Shelby American, Inc.
Location: Huntington Beach
Posted on: April 22, 2025

Job Description:

Verda Healthcare, Inc. has a contract with the Center of Medicaid and Medicare Services (CMS) and Texas Department of Insurance for a Medicare Advantage Prescription Drug (MAPD) plan. We are committed to the idea that healthcare should be easily and equitably accessed by all. Our mission is to ensure that underserved communities have access to health and wellness services, and receive the support needed to live a healthy life that is free of worry and full of joy. We are looking for an EDI Specialist to join our growing company with many internal opportunities.Are you ready to join a company that is changing the face of health care across the nation? Verda Healthcare, Inc. is looking for people like you who value excellence, integrity, care and innovation. As an employee, you'll join a team dedicated to improving the lives of our Medicare members. Our vision incorporates value-based health care that works. We value diversity.Align your career goals with Verda Healthcare, Inc. and we will support you all the way.Position OverviewThe EDI Specialist role will analyze, troubleshoot, and support data interchanges and supporting processes. This role will ensure these processes are working properly to enable the efficient exchange of information between organizations or among internal units within Verda Healthcare. This professional will be responsible for assessing the business needs, analyzing data interchange files, maintaining, and troubleshooting EDI issues with an eye towards root cause analysis and optimization.This position reports to the Chief Information Officer (CIO) as part of the Verda Health Plan of Texas information technology team.Responsibilities:

• Maintenance, troubleshooting, and support of existing data interchanges, including ingestion, extraction, and reconciliation of data files from all sources.
• Support and remediation of files and data sent to regulatory partners, including CMS. Serve as the primary resource for researching and correcting encounter data rejections.
• Provide education to internal resources and external trading partners concerning EDI guidelines and capabilities.
• Analyze data, business rules, and companion guides to create accurate and effective EDI mapping documents for existing and new data interchanges.
• Analyze requirements, test systems, export data in EDI formats, and be able to load and transform EDI files into accessible data formats.
• Document all analysis and reporting projects following established department protocols to ensure transparency and repeatability.
• Create and operate within time-based workflows, ensuring data interchange occurs on time and within accuracy constraints of trading partners and regulators.
• Maintain knowledge of existing and emerging regulatory changes and how they impact operational processes and beyond.
• Operate and maintain SFTP connections with existing and new trading partners, including working with IT resources to implement SFTP connections.
• Collaborate with other departments and trading partners to research, identify, and correct systemic data errors and ensure data is of the highest quality.Minimum Qualifications
• Bachelor's degree in management systems, computer science, information systems or information technology preferred; or equivalent experience.
• 2+ years of experience with Microsoft SQL is required (At least 2 years, intermediate proficiency or better).
• Thorough knowledge of MS Office Suite particularly Excel.
• Minimum of 2-3 years of EDI experience in a health plan or managed care is preferred.
• Demonstrated experience and understanding of data sets and formats such as ANSI files: X12, HL7, and FHIR standards.
• Hands-on experience having implemented 834 & 837 files for a health plan, build and troubleshoot carrier forms, and ensure accurate and efficient data exchange.
• Proven ability to impact process improvement and efficient operations.
• High level of business and technical knowledge with significant practical experience in healthcare administration or operations preferred.Professional Competencies
• Skilled and passionate about requirement gathering, root cause analysis, and problem solving.
• Collaborative and humble approach with internal and external resources.
• Effective verbal and written communication.
• Passion for building solutions, taking the initiative, and being accountable for their work.Verda cares deeply about the future, growth, and well-being of its employees. Join our team today!Job Type: Full-timeOnsite: 100% in officeBenefits:

• 401(k)
• Dental Insurance
• Health insurance
• Life insurance
• Paid time off.
• Vision insuranceSchedule:8-hour shiftMonday to Friday/Weekends as neededAbility to commute/relocate:Reliably commute or planning to relocate before starting work (Required)PHYSICAL DEMANDSRegularly sit/walk at a workstation in an office or cubicle setting. Must occasionally lift and/or move up to 25-50 pounds.*Other duties may be assigned in support of departmental goals.
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Keywords: Shelby American, Inc., Los Angeles , EDI Specialist, Other , Huntington Beach, California