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Healthcare EDI Specialist - Ontario, CA

UnitedHealth Group

Ontario, CA
Job Code:
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Job Details

738524 Healthcare EDI Specialist Ontario CA

Healthcare EDI Specialist - Ontario, CA (738524)

Position Description

Position Description:

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.(sm)

This role will provide Healthcare EDI expertise and support by reviewing, researching, investigating EDI transactions. This role will analyze and identify trends and provide reports as necessary for inbound and outbound EDI transactions. Consistently meet established productivity, schedule adherence, and quality standards. Facilitate as EDI Subject Matter Expert between internal / external customers to maintain positive working relationships with all trading partners, key health plan stakeholders, departments and / or the IPA.

Primary Responsibilities:
  • Coordinate meetings with Clearinghouse representative, Health Plans, and Medical Groups and / or provider networks, to resolve potential missing encounter data
  • Ability to independently implement moderate to complex electronic data transactions (ANSI X12 837, 835, 277CA and 999)
  • Perform User Acceptance testing (create test scenarios, execute test cases, document defects, report results)
  • Assist with coordinating the implementation of new EDI  trading partners
  • Monitor routine reporting between Clearinghouses, Health Plans and / or  Provider networks to maintain regulatory compliance with EDI transmission reconciliation
  • Analyze and resolve encounter data discrepancies resulting from EDI transaction errors
  • Accountable for identifying root cause issues thereby mitigating repeated occurrences
  • Regularly exercises critical thinking to determine best method for accomplishing work and achieving objectives.
  • Maintain frequent and effective communication standards with internal and external customers.
  • Performs any other assigned duties as required by company and / or department
Required Qualifications:
  • High School Diploma / GED
  • 5+ years of experience analyzing and solving customer problems in an office setting environment
  • 3+ years of operational EDI experience with one or more of the Healthcare X12 transaction sets (820, 834, 835, 837P, 837I, 270 / 271, 276 / 277, 277CA, 997 or 999) and ability to interpret implementation guides.
  • Moderate proficiency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
Preferred Qualifications:
  • Some College (or higher)
Soft Skills:
  • Ability to multi - task, this includes ability to understand multiple products and multiple levels of benefits within each product
  • Ability to work independently given minimal direction
  • Proven ability to take responsibility and be accountable
  • Should be Innovative, adaptable and flexible
  • Has proficient knowledge of claim operations.
  • Ability to deliver proven departmental results
  • Ability to prioritize work flows
  • Ability to identify issues and resolve them cooperatively
  • Requires excellent communication skills, both written and verbal
  • Able to represent the company in a professional and positive manner
  • Ability to retain composure in stressful situations
  • Excellent investigational skills
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Details

  • Contest Number738524
  • Job TitleHealthcare EDI Specialist - Ontario, CA
  • Job FamilyClaims
  • Business SegmentOptum Operations

Job Location Information

  • Ontario, CA
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionNo
  • Overtime StatusNon-exempt

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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