Overview
On Site
$82,000 - $110,000 annually
Full Time
Skills
Management
Microsoft Exchange
Data Extraction
Reporting
Scripting
Workflow
Managed Services
ASC X12
Technology Assessment
ICD-10
HCPCS
Medicare
Medicaid
Health Care
Electronic Data Interchange
SQL
Microsoft Excel
Pivot Table
VLOOKUP
Microsoft Office
Microsoft Outlook
Python
Microsoft SSIS
Artificial Intelligence
Messaging
Job Details
RESPONSIBILITIES:
Kforce has a client in Montebello, CA that is in need of a Healthcare 837 EDI Specialist.
Responsibilities:
* Interpret ASC X12 837 files (837P and 837I), identifying loops and segments
* The Healthcare 837 EDI Specialist will manage EDI claims submission, exchange, and reconciliation
* Process related files: 837D, 277CA, 999, and TA1
* Respond to EDI acknowledgments and error reports, identifying accepted vs. rejected claims
* Write and modify intermediate-level SQL queries for data extraction, updates, and reporting
* Perform update statements, joins, and CASE logic
* Maintain and update SQL scripts based on requirements
* Analyze and troubleshoot healthcare claims data using SQL
* Python scripting for automating EDI tasks is a plus
* The Healthcare 837 EDI Specialist will map claim form fields to EDI segments
* Understand healthcare claims workflows and EDI clearinghouses
REQUIREMENTS:
* Bachelor's degree or equivalent experience required
* 4+ years in managed health care, preferably with a Health Plan or Managed Services Organization
* 2+ years with ASC X12 837 files (837P, 837I, 837D, 277CA, 999, TA1)
* 2+ years generating and submitting healthcare EDI files, with SQL knowledge
* Knowledge of ICD-10, CPT, HCPCS, NDC coding, and EDI Clearinghouses
* Familiarity with Medicare, Medicaid, and Commercial healthcare lines is a plus
* Skilled in reading and interpreting raw EDI files
* Intermediate SQL skills for joins, updates, and complex queries
* Advanced Excel skills: pivot tables, sorting, filtering, VLOOKUP/XLOOKUP, formulas
* Proficient with Microsoft Office tools, especially Outlook and Word
* Exposure to Python or SSIS is a plus
The pay range is the lowest to highest compensation we reasonably in good faith believe we would pay at posting for this role. We may ultimately pay more or less than this range. Employee pay is based on factors like relevant education, qualifications, certifications, experience, skills, seniority, location, performance, union contract and business needs. This range may be modified in the future.
We offer comprehensive benefits including medical/dental/vision insurance, HSA, FSA, 401(k), and life, disability & ADD insurance to eligible employees. Salaried personnel receive paid time off. Hourly employees are not eligible for paid time off unless required by law. Hourly employees on a Service Contract Act project are eligible for paid sick leave.
Note: Pay is not considered compensation until it is earned, vested and determinable. The amount and availability of any compensation remains in Kforce's sole discretion unless and until paid and may be modified in its discretion consistent with the law.
This job is not eligible for bonuses, incentives or commissions.
Kforce is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, protected veteran status, or disability status.
By clicking ?Apply Today? you agree to receive calls, AI-generated calls, text messages or emails from Kforce and its affiliates, and service providers. Note that if you choose to communicate with Kforce via text messaging the frequency may vary, and message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You will always have the right to cease communicating via text by using key words such as STOP.
Kforce has a client in Montebello, CA that is in need of a Healthcare 837 EDI Specialist.
Responsibilities:
* Interpret ASC X12 837 files (837P and 837I), identifying loops and segments
* The Healthcare 837 EDI Specialist will manage EDI claims submission, exchange, and reconciliation
* Process related files: 837D, 277CA, 999, and TA1
* Respond to EDI acknowledgments and error reports, identifying accepted vs. rejected claims
* Write and modify intermediate-level SQL queries for data extraction, updates, and reporting
* Perform update statements, joins, and CASE logic
* Maintain and update SQL scripts based on requirements
* Analyze and troubleshoot healthcare claims data using SQL
* Python scripting for automating EDI tasks is a plus
* The Healthcare 837 EDI Specialist will map claim form fields to EDI segments
* Understand healthcare claims workflows and EDI clearinghouses
REQUIREMENTS:
* Bachelor's degree or equivalent experience required
* 4+ years in managed health care, preferably with a Health Plan or Managed Services Organization
* 2+ years with ASC X12 837 files (837P, 837I, 837D, 277CA, 999, TA1)
* 2+ years generating and submitting healthcare EDI files, with SQL knowledge
* Knowledge of ICD-10, CPT, HCPCS, NDC coding, and EDI Clearinghouses
* Familiarity with Medicare, Medicaid, and Commercial healthcare lines is a plus
* Skilled in reading and interpreting raw EDI files
* Intermediate SQL skills for joins, updates, and complex queries
* Advanced Excel skills: pivot tables, sorting, filtering, VLOOKUP/XLOOKUP, formulas
* Proficient with Microsoft Office tools, especially Outlook and Word
* Exposure to Python or SSIS is a plus
The pay range is the lowest to highest compensation we reasonably in good faith believe we would pay at posting for this role. We may ultimately pay more or less than this range. Employee pay is based on factors like relevant education, qualifications, certifications, experience, skills, seniority, location, performance, union contract and business needs. This range may be modified in the future.
We offer comprehensive benefits including medical/dental/vision insurance, HSA, FSA, 401(k), and life, disability & ADD insurance to eligible employees. Salaried personnel receive paid time off. Hourly employees are not eligible for paid time off unless required by law. Hourly employees on a Service Contract Act project are eligible for paid sick leave.
Note: Pay is not considered compensation until it is earned, vested and determinable. The amount and availability of any compensation remains in Kforce's sole discretion unless and until paid and may be modified in its discretion consistent with the law.
This job is not eligible for bonuses, incentives or commissions.
Kforce is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, protected veteran status, or disability status.
By clicking ?Apply Today? you agree to receive calls, AI-generated calls, text messages or emails from Kforce and its affiliates, and service providers. Note that if you choose to communicate with Kforce via text messaging the frequency may vary, and message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You will always have the right to cease communicating via text by using key words such as STOP.
Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.