Adjudication, Business Analysis, Business Processes, Claims Processing, Documentation, Electronic Data Interchange (EDI), Federal Government, Health Insurance, Healthcare Providers, Help Desk, Insurance Claims, Microsoft .NET, Onboarding, Pricing, Project Management Software, Requirements Management, Software Development, Team Player, Transaction Processing/Management
advance its health insurance claims processing system, ACAPS.
The EDI Expert is responsible for maintaining the life cycle of claims as they arrive from health providers at IDOH, are loaded into our database, are adjudicated based on state and national pricing standards, and as adjudication messages are generated and sent back to the originating provider. This position will work with the project manager, software developers, business analysts, and functional team members on the project activities.
Essential Duties / Responsibilities:
"Review update all documentation related to claims processing and EDI transactions
"Identify incompletely documented claims processing and EDI processes, and document them
"Work with development team as a SME as IDOH s ACAPS system is rewritten in .Net
"Act as liaison between OTC team and the Children s program area on claims processing issues
"Working with technical and functional staff on detailed business requirements, understanding business processes and technology, agency standards, federal and state policies to align with project s goals.
"Write technical specifications based on conceptual design and stated business requirements.
"Test new and existing systems
"Ensure accurate and appropriate file exchanges with external trading partners and resolve EDI data transmission conflicts.
"Provide helpdesk level support for EDI claim transactions.
oProvide support to healthcare providers who interact with IDOH s CSHCS system
oAssist in onboarding new providers
oAssist in onboarding new clearinghouses
"Ability to work independently with less guidance and work with ISDH externals partners as needed.T
Tekfortune Inc.
Tekfortune is a software solutions company providing project development and staff augmentation services to companies in various industries including Healthcare, Banking, Finance, Telecommunication and Aviation.
Tekfortune Inc delivers solutions to a wide variety of organizations of various sizes and industries. Our clients include mid-market to Fortune 1000 companies spanning across industries such as: Insurance, Financial, Pharmaceutical, Manufacturing, Retail and many others.
In Tekfortune Inc, we are offering selection of services and solutions at very reasonable rates. With years of experience in the placement and recruitment Industry and over time we have acquired the knowledge essential to comprehend the exact need and dependence on customers. Therefore we provide the customers the best and also the brightest candidates for vacancies. Moreover, by understanding the working interest of customers who is able to place them within the companies where they are able to get maximum opportunity for professional growth.
Tekfortune Inc has a strong emphasis on quality. Its goal would be to achieve client satisfaction by looking into making deliveries satisfaction of customer's business needs. Our ability to quickly identify and effectively employ proven fundamental principles, techniques and resources yields highly desirable results for our clients.
We understand that each industry and organization share a level of uniqueness that requires a tailored approach in order to deliver specific solutions. Such factors as client culture, industry regulations, organizational maturity, financial health and many more items may impact our approach to delivering client solutions.
Having served a wide variety of clients has provided Tekfortune the ability to build subject matter expertise across numerous industries. Our industry expertise combined with our specialized knowledge of Business Process Improvement, Requirements Management and Program & Project Management provides a powerful combination and a tremendous value to our clients.
We are run by a group of industry experts who have decades of experience in delivering custom solutions to our clients.
20 to 49 employees
http://www.tekfortune.com/