EDI Specialist

Location: Philadelphia, PA
Salary: $30.00 USD Hourly - $31.00 USD Hourly
Description: Our client is currently seeking a EDI Specialist
- Philadelphia, PA

W2 - EDI Specialist-Philadelphia-Hybrid

Philadelphia, PA 19103

Role Summary

This position requires strong expertise in EDI Portal management and inbound EDI enrollment file activity
, with responsibility for ensuring successful data transfers, troubleshooting integrity issues, and supporting complex client business processes. The role also involves direct client/team interaction
, project participation
, and robotic process automation (RPA) oversight
.

Key Duties & Requirements

• Manage inbound EDI enrollment file activity and troubleshoot/reconcile data integrity issues.
• Handle EDI file activity for high-profile/complex client business (BPO, Shared Services, non-standard).
• Serve as direct contact between EDI senders, clients, Account Management, Customer Experience, Biz Talk/.Net, and project teams.
• Lead/participate in project meetings, sprint work, documentation, system upgrades, and business check-outs.
• Manage robotic process automation (RPA) work for the business area.
• Support Business Systems Analyst with client-specific EDI enrollment testing.

Additional Responsibilities

• Develop user system documentation and desk-level procedures.
• Manage daily team inventory activity; provide support/training/direction to Eligibility Specialists.
• Participate in Enrollment Resolver Group for issue resolution.
• Organize/disperse team project work.
• Assist with manual enrollment processing across all lines of business.
• Support Member Enrollment System platform (development, inquiries, EDI file activity).
• Meet departmental quality and production standards.
• Perform other duties as assigned by leadership.

Qualifications

• Ability to work with multiple business systems; general understanding of system design.
• Proficiency in Microsoft Office and project management tools.
• Strong oral and written communication skills.
• Detail-oriented with understanding of corporate business systems.
• Ability to work independently and investigate/test/present findings.
• Technical writing skills.
• Related enrollment experience in Health Rules system platform; understanding of Front Office System and EDI Portal interaction.

Education & Experience

• Bachelor's degree in Business Administration, MIS, Computer Science, or equivalent healthcare/technology experience.
• Knowledge of XML/ANSI 834 / HIPAA X12 transactions beneficial.
• In lieu of degree: 2-3 years proven EDI/eligibility experience.
• Strong communication and analytical skills required.

Scope

• Working knowledge and experience in discipline.
• Builds knowledge of organization, processes, and customers.
• Performs straightforward assignments using prescribed guidelines/policies.
• Receives moderate guidance/direction from senior roles

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Contact:

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