Provider Relations Specialist

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.