Job description

Location: Ridgeland, MS, USA Pay Rate:
Pay Type: Benefits: Medical, Dental, Vision, 401K and Paid Time Off
Employment Type: Full Time

The EDI Provider Relations Specialist reports to the Claims Department Manager in the MWG-Administrators Division.

The position a non-exempt, hourly role and is located at 500 Steed Road, Ridgeland, MS 39157.

GENERAL JOB DUTIES AND RESPONSIBILITIES:
The EDI Provider Relations Specialist ensures the EDI File transfer process between the TPA, and external vendors functions properly, and that data conforms to MWG standards and will also perform testing and troubleshooting prior to implementation to help develop the program. This is critical to correctly matching members and paying claims. Additionally, the position will work with providers to resolve any questions or problems with claims. To perform the job successfully, the employee must be able to perform each essential duty satisfactorily. The requirements listed here are representative of the knowledge, skill, and ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Interact via written and oral communication with providers regarding questions to claims.
Act as the point person for daily and weekly Electronic Data Interchange (EDI) files.
Review EDI files to ensure data accuracy and correct matches with CHS.
Assist with the successful implementation of the MWG Claims system programming is currently building
Troubleshoot errors on EDI files
Test new claim file feeds daily
Conduct Claims reporting as needed.
Be knowledgeable and have a clear understanding of the business processes within MWG internally and externally.
Utilize MWG Administrators Policy Administration System and Claims Management Software to verify eligibility and review member accounts based on the policy assigned.
Input data into the MWF Admin Claims Management Software.
Perform other duties as assigned by the department manager.

EXPERIENCE AND EDUCATION REQUIREMENTS:
High School Diploma or GED required; Associates or bachelor's degree is preferred.
Must have 1-2 years of previous insurance claims experience; previous experience with electronic data interchange (EDI) of files is preferred.
Must have excellent computer skills and have strong knowledge of Microsoft Outlook, Windows, Excel, and Word.
Must understand and be proficient with the software utilized in the TPA department.
Must possess time management, organizational, problem solving, and customer service skills.
Must be able to work well under pressure with multiple priorities and meet deadlines.
Must be able to multitask while maintaining attention to details.

WORKING ENVIRONMENT:
Must be able to perform in a very high paced environment and professionally handle interruptions.
Must have the ability to work under minimal supervision.
Must be able to prioritize projects, work multiple projects simultaneously, and meet project deadlines.
Must possess excellent problem-solving skills and have keen attention to details.
Must demonstrate strong written and verbal communication, interpersonal, and relationship building skills.
Must be able to handle stressful situations appropriately.
Must maintain confidentiality and privacy in every aspect of the job.

JOB ESSENTIAL REQUIREMENTS:
The following are job functions that an employee must be capable of performing with or without reasonable accommodation.

Must be able to read, write, and speak English; Spanish is a plus.
Must have basic typing skills
Must be able to work as scheduled.
Must possess sight and hearing senses or use prosthetics that will enable these senses to function adequately so that the requirements of the position as stated above can be fully met.
Must be able to bend, stretch, reach, and sit or stand at a desk during 85% of the workday.
Must be able to lift, stoop, and carry small equipment items and supplies, possibly weighing up to 20lbs.

MWG is an Equal Opportunity Employer, committed to the principles of the EEOC. All employment decisions are based upon each person's qualifications, abilities, and performance. Our company works to provide an environment where human dignity prevails and all employees and applicants for employment receive equal consideration and fair treatment, without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

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