EDI Operations Analyst

Department: Operations - EDI Operations

Reports to: Sr. Manager, Technical Analysis

Location: Idlewild Ave, Tampa FL 33634

Responsible for working with providers to set up and maintain electronic transactions including electronic data interchange (EDI); electronic fund transfers (EFT) and other web site services. Serves as liaison to WellCare’s providers, vendors and internal departments for any issues involving paper to electronic (P2E) process of claims data.

Essential Functions:

  • Communicate with provider community via phone and email on electronic data issues to support Customer Service Tool (CMR)
  • Perform expansion or issue related Provider Call Campaigns to assist providers with connectivity or adjusting billing practices to overcome edits.
  • Coordinate provider issues with appropriate internal departments, performs accurate and timely provider research, verification and analysis
  • Support compliance with federal, state and HIPAA regulations
  • Work with internal IT EDI/HIPAA Trading Partner Coordinator for testing and development
  • Analyze and edit electronic formats
  • Collects data and performs analysis and tests systems and improve outcomes/accuracy
  • Tracks trends and issues, validates with in-depth data and analysis; applies solutions quickly
  • Audit vendor outputs to ensure SLA compliance and accuracy standards
  • Maintain daily provider contact logs
  • Works on EDI help desk queue
  • Updates tracking database.
  • Assists in special projects
  • Creates training and marketing material for provider community and other departments such as Provider Relations and Customer Service
  • Performs other duties as assigned.
Candidate Education:
  • Required: High School or GED
  • Preferred: Associate's Degree in a related field
Candidate Experience:
  • Required: 2 years of related experience in a customer service and/or EDI environment
  • Preferred: 1 year of healthcare experience
Candidate Skills:
  • Demonstrated written communication skills
  • Demonstrated interpersonal/verbal communication skills
  • Ability to effectively present information and respond to questions from families, members, and providers
  • Demonstrated analytical skills Ability to read, analyzes, and interprets verbal and written instructions.
  • Ability to define problems collects data, establish facts, and draw valid conclusions
  • Ability to apply sound judgment and decision-making skills in dealing with a variety of routine and non-routine issues, often with limited standardization
Technical Skills:
  • Microsoft Excel
  • Microsoft Word
  • Microsoft PowerPoint

*LI-JC1

About us
Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses exclusively on providing government-sponsored managed care services through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans to families, children, seniors and individuals with complex medical needs. WellCare is a Fortune 500 company, and in 2018, was recognized as a Fortune "World's Most Admired Company", ranking in the top five among the health insurance and managed care industry-a testament to the hard work and dedication of the company's nearly 9,000 associates who each day live WellCare's values and deliver on its mission to help its members live better, healthier lives. The company serves approximately 4.4 million members nationwide as of Dec. 31, 2017. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.