Associate, Group EDI

Over 35 years strong and fueled by 1,700 smart, passionate employees across New York state and Vermont, MVP is full of opportunities to grow. We are a nationally recognized, award-winning leader for a reason. The beating heart of our company is a wide range of employees from a diverse set of backgrounds—tech people, numbers people, even people people—working together to make health insurance better. If you are ready to join a thriving, mission-driven company where you can create your own opportunities and make a positive difference—it’s time to make a healthy career move to MVP!

Full-Time, Non-Exempt

The Group EDI Associate is responsible for the coordination of all EDI enrollments and eligibility functions including but not limited to implementation, processing, reconciliation, and quality control. They are required to identify any errors within the EDI process and coordinate with internal and external customers for resolution. The associate will work directly with internal and external customers.
Essential Job Functions

• Maintain EDI reporting for audit and departmental purposes.
• Manage Quality Control documentation.
• Implement SFTP gateway for vendors to upload their 834 5010 files securely to MVP.
• Work directly with employer groups, vendors, and Health Benefit Administrators to configure and test new and existing EDI groups.
• Ensure new EDI groups meet MVP’s current mapping procedures to maintain operational efficiencies.
• Maintain a complete understanding of the 834 HIPPA 5010 transactions, and MVP’s proprietary layout.
• Work with vendors when their EDI files have failed compliancy to resolve errors.
• Work with internal/external clients on any 834 5010 file changes needed at EDI groups renewal.
• Responsible for identifying trending errors and implement solutions with internal and external customers
• Process daily error reporting and monthly system reconciliation files.
• Track all EDI enrollment activities to ensure files are received and loaded as scheduled.
• Maintain and complete all reporting of ASO/EDI transactions and schedules to ensure all performance guarantees are met.
• Process any manual membership updates received by email and/or queues and follow-up with vendor to ensure updates are reflected in their eligibility files.
• Assist new and existing EDI clients with any questions.
• Respond to eligibility inquiries related to Group EDI membership.

OTHER DUTIES & RESPONSIBILITIES:

• Serve as a team player in supporting the departmental goal of a high level of customer service through continuous quality improvement.
• Maintain departmental standards of production levels and quality scores.
• Ability to navigate and utilize multiple systems for processing.
• Facilitate implementation meetings with external and internal areas.
• Perform other duties as assigned.

POSITION QUALIFICATIONS

Minimum Education:
Associates degree or equivalent combination of education and directly related experience preferred

Minimum Experience:
Prior Group Operations/Enrollment/Billing experience preferred.1-2 years’ experience in Business Administration, Health Care Administration or related fields required.

Required Skills:

• Strong skills required in critical thinking, problem analysis, verbal/written communication, and interpersonal interactions
• Familiarity with healthcare benefits and/or medical terminology
• Experience in positions where adherence to strict confidentiality is required
• Able to work in team environment and independently
• Possess sense of accountability and urgency in completing assignments
• Proven skills in process analysis, system documentation, and workflow definition
• Proficient in Facets
• Strong PC skills

About MVP
MVP Health Care is a nationally recognized, not-for-profit health insurer caring for more than 700,000 members in New York and Vermont. Committed to the complete well-being of our members and the communities we serve, MVP makes health insurance more convenient, more supportive, and more personal. We are powered by the ideas and energy of more than 1,700 diverse, employees from all backgrounds, committed to having a positive impact on the health and wellness of everyone we serve. MVP Health Care is an Affirmative Action/ Equal Employment Opportunity (PDF). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency (PDF), and the Know your Rights protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at hr@mvphealthcare.com

Please apply and learn more – including how you may become a proud member of our team.