EDI Eligibility Specialist

Bham-Corporate Office Birmingham, AL 35203, USA

Electronic Data Interchange (EDI) Eligibility Specialist

Location: Birmingham, AL

VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.

VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.

• Comprehensive Health, Vision, and Dental Coverage
• 401(k) Savings Plan with company match and immediate vesting
• Paid Time Off (PTO)
• 9 Paid Holidays annually plus a Floating Holiday to use as you choose
• Tuition Assistance
• Flexible Spending Accounts
• Community Service Time Off
• Life Insurance and Disability Coverage
• Employee Wellness Program
• Training and Development Programs to develop new skills and reach career goals

The EDI (Electronic Data Interchange) Eligibility Specialist will develop and maintain existing eligibility EDI programs and other PC-based programs for VIVA HEALTH. This position will assist with the maintenance and execution of recurring processes surrounding eligibility business requirements.

• Carry out the end-to-end steps to receive and transform data to be loaded into VIVA HEALTH’S systems.
• Work closely with the Finance, Operations, and Medicare departments to support their respective business functions surrounding enrollment.
• Work with third party vendors to analyze and setup appropriate processes for and claims data feeds from VIVA HEALTH’S systems.
• Work with the Compliance/Legal departments to ensure proper documentation is in place before data feeds are setup.

• Bachelor’s Degree or equivalent work experience
• 1-3 years’ experience with database technology/process management
• Demonstrated experience with successful ownership of processes
• Excellent interpersonal skills for frequent interaction with users, managers, and vendors
• Excellent verbal and written communications skills
• Excellent attention to detail and accuracy
• Knowledge of MS Access

• 3–5 years’ experience with database technology/process management
• Experience with MS SQL
• Microsoft and/or PMI certifications
• Understanding of the relationship between health plan eligibility and premium accounting
• Knowledge of ANSI  file formats
• Knowledge of HIPAA and ACA

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.

For further information, please review the Know Your Rights notice from the Department of Labor.