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EDI Healthcare Representative

Company: HMS
Location: Jackson
Posted on: November 26, 2022

Job Description:

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development.


The Insurance/Healthcare job contains positions associated with providing consultancy utilizing knowledge and expertise on insurance and healthcare. Also includes background in incident/problem management with X-12 and EDI experience. The EDI specialist serves as the primary link between the business and any data-trading partners. Develops and implements general insurance and health policies in accordance with state and federal laws. Provides expertise to investigate and adjudicate claim characteristics that do not match policy provisions. Response to provider appeals and meets with trading partners and providers to resolve problems/issues. Provides directions for utilization review. Approves any remedial or recoupment actions associated with escalated claims. Advises provider review councils, states officials and works with organized healthcare groups and associations on various issues related to insurance and healthcare programs.

Your role in our mission

* Participates productively as a member of the team in a team lead role.
* Completes complex tasks, assignments and defined processes with some level of independence.
* Multiple assignments worked and completed simultaneously as directed by leadership.
* Identifies, prioritizes and resolves most question and issues independently. Answers questions of peers. Escalates more complex questions or issue appropriately.
* Complies with contract requirement, business unit rules and related industry and legal regulations.

What we're looking for

* EDI Experience, X-12 knowledge
* Office administrative experience and skills
* Ability to follow written policies, procedures and guidelines, and give feedback to leadership, and Intermediate-level knowledge of operating systems.
* Ability to read and interpret basic to moderately complex documents such as operation and maintenance instructions, procedure manuals and government/healthcare guidelines.
* Excellent written and verbal communication skills and customer service skills, including professional telephone skills.

What you should expect in this role

Education and Experience:

High School Diploma or equivalent; may hold 2 year post-high school Degree; may hold Bachelor's degree. Typical, 2-4 years of working experience in related fields.

The pay range for this position is $33,500.00 - $47,900.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You'll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You'll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.

Keywords: HMS, Jackson , EDI Healthcare Representative, Healthcare , Jackson, Mississippi

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