Claims & Encounter EDI Coordinator

Claims & Encounter EDI Coordinator

Under the direction of the Sr. Director of Healthcare Analytics, this position is responsible for the accurate and timely processing, tracking, and transmission of electronic claim and encounter files. This is a highly structured, process-driven position with established daily, weekly, and monthly responsibilities. Primary duties include receiving and in-loading claim transaction files into EZ-CAP for claims adjudication, monitoring file processing, maintaining required logs and reconciliations, and creating and transmitting encounter files to clearinghouses and other trading partners according to established schedules. Success in this position requires exceptional attention to detail, organization, consistency, and reliability. The ideal candidate is comfortable performing routine, repetitive processes, following detailed written procedures, maintaining accurate records, and completing time-sensitive tasks according to an established schedule. The successful candidate must be able to follow procedures carefully, recognize discrepancies or processing issues, and promptly escalate problems rather than bypassing established steps. This position is particularly well suited for an individual who enjoys structured work, clearly defined responsibilities, independent task completion, and the satisfaction of ensuring that recurring operational processes are completed accurately and on time. For individuals interested in professional development, this position also provides an opportunity to build foundational knowledge of healthcare EDI, claim and encounter processing, and electronic data exchange. The Claims & Encounter EDI Coordinator will interact with other departments, clinic personnel, and outside providers in a professional and friendly manner, to create and maintain a positive relationship with our internal and external customers.

Primary Responsibilities:

• Receive and in-load daily electronic claim transaction files into EZ-CAP according to established procedures and schedules.
• Run required daily processes to prepare claims for adjudication.
• Verify that expected files have been received and processed successfully and identify missing, duplicate, rejected, or incomplete files.
• Maintain daily processing logs, reconciliation records, and other required tracking documentation.
• Create, validate, and securely transmit encounter files to the designated clearinghouse or trading partner according to established weekly schedules.
• Review clearinghouse acknowledgements and rejection reports and complete documented correction or follow-up procedures.
• Reconcile claim and encounter file receipt and submission activity to help ensure complete and timely transfer of data.
• Follow established HIPAA-compliant procedures for the secure transmission and handling of electronic healthcare information.
• Complete daily, weekly, and monthly processing tasks accurately and within required deadlines.
• Follow written procedures, processing checklists, and established workflows consistently and maintain documentation when processes change.
• Identify unusual results, processing failures, discrepancies, or issues and promptly escalate them to the appropriate team member or supervisor.
• Communicate pending items, processing issues, and potential missed deadlines to the supervisor in a timely manner.
• Assist with testing of new or modified claim and encounter processes as directed.
• Other duties as assigned.

Required Qualifications:

• High School Diploma or equivalent.
• Experience in a detail-oriented administrative, healthcare, claims, billing, data-processing, or transactional environment.
• Strong computer skills
• Dependable and able to consistently complete time-sensitive daily and weekly responsibilities according to established schedules.
• Ability to maintain accuracy and attention to detail while performing repetitive or routine tasks.
• Demonstrated ability to follow detailed written procedures
• Strong organizational skills
• Ability to manage recurring deadlines

Preferred Qualifications:

• Claims processing, encounter processing, medical billing, managed care, clearinghouse, EZ-CAP, or similar healthcare information system experience.

The pay range for this position at commencement of employment is expected to be reasonably between $28.57 and $33.62. However, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, skills, and experience. If hired, employee will be in an "at-will position" and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.