Eligibility Specialist

Houston, TX | Contractor

Post Date: 04/10/2018 Job ID: JHT3K96KS56MGGBLG2K Industry: Health Care, Nurse



Responsibility A: Monitors daily EDI file function and error reporting; resolves file errors.
Processes electronic claims and eligibility files and loads files into the claims processing system.
Communicates with vendors and clients regarding day-to-day EDI transactions.
Monitors error reports and resolves transaction errors for EDI processes.
Monitors, reports and tracks error trends to manage resolution initiatives.
Works in partnership with IT on testing and implementation of new files and/or file changes, as needed.
Responsibility B: Provides support and researches solutions for user issues which cannot be resolved by the
Service Desk.
Receives calls forwarded from Service Desk, which cannot be resolved by Service Desk.
Communicates with users to determine the problem.
Identifies scope of problem and impact to other users.
Analyzes problem and researches alternative solutions.
Determines appropriate solution and makes necessary changes.
Escalates problem to other IT staff if necessary.
Responsibility C: Reviews implementations, conducts testing and assists with new releases.
Partners with IT to collaborate with trading partners to resolve any operational issues.
Coordinates and tests all EDI implementations with new EDI partners.
Analyzes current implementation in order to make recommendations for improvements.
Assists with testing of new releases on the claims processing system and troubleshoots problems prior to loading into
production.
Assists with projects including group and vendor implementations and data projects.


High School Diploma or GED and 4 years Work experience in electronic data interchange (EDI) or
health plan data and applications.


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