Responsible for working with providers to set up and maintain electronic transactions including electronic data interchange (EDI); electronic fund transfers (EFT) and other web site services. Serves as liaison to Whalen's Customers, vendors and internal departments involving electronic and paper submission of provider and member correspondence. Performs root cause analysis of issues associated with electronic and paper submission.
- Communicate with providers, vendors, and internal departments to resolve electronic and paper submission issues.
- Perform "root cause" analysis on identified electronic and paper submission issues.
- Work with vendors to build positive business relationships and provide quick resolution to issues.
- Analyze reports to identify issues such as incorrect electronic submission and incorrect routing of paper correspondence.
- Coordinate provider issues with appropriate internal departments, performs accurate and timely provider research, verification and analysis.
- Analyzes data to evaluate operational difficulties and makes recommendations to solve problems.
- Assists with special projects.
- Performs analysis and tests systems and improve outcomes/accuracy.
- Conducts daily, weekly and monthly quality audits ensuring accuracy across multiple systems.
- Tracks trends and issues, validates with in-depth data and analysis; applies solutions quickly.
- Work with internal IT EDI/ Trading Partner Coordinator for testing and development.
- Maintain daily provider contact logs.
- Works on EDI help desk queue.
- Analyze and edit electronic formats.
- Maintains an understanding of department processes in order to research and identify improvement opportunities.
- Tracks and maintains quality results for appropriate distribution.
Performs other duties as assigned