MAXIMUS

  • EDI Supervisor

    Job Locations US-MA-Boston
    Posted Date 3 months ago(10/18/2019 10:28 AM)
    Requisition ID
    2019-45600
    # of Openings
    1
    Job Schedule
    Regular Full-Time
  •  

    Since 1975, MAXIMUS has operated under its founding mission of Helping Government Serve the People, enabling citizens around the globe to successfully engage with their governments at all levels and across a variety of health and human services programs. MAXIMUS delivers innovative business process management and technology solutions that contribute to improved outcomes for citizens and higher levels of productivity, accuracy, accountability and efficiency of government-sponsored programs. With more than 30,000 employees worldwide, MAXIMUS is a proud partner to government agencies in the United States, Australia, Canada, Saudi Arabia, Singapore and the United Kingdom. For more information, visit https://www.maximus.com.

    Job Description Summary

    MAJOR PURPOSE

    The EDI Supervisor oversees and manages the daily activities for a team of EDI Specialists, monitors workflow, maintains quality standards and ensures file integrity within the department.

    JOB SUMMARY

    • Assign work daily to staff to ensure that daily production goals are met and prioritize work where necessary
    • Monitor employee performance for compliance to established protocol (SLA). Supervisor will review production reports and work queue items and compare them to established performance expectations
    • Review reports and feedback to develop strategies to improve production and quality and ensure compliance
    • Effectively lead, coach, train and counsel staff and applies feedback to improve performance
    • Provides analytical and trend reporting
    • Identifies opportunities, develops best practices and process improvements
    • Research and respond to any escalated provider inquiries and requests in a timely, professional and informative manner
    • Educate EDI specialists on updates and system changes to ensure synchronized process of data and documentation to meet regulatory guidelines and standards
    • Establishes and maintains relationships with MAXIMUS CSC Leadership and EOHHS Leadership as appropriate, to ensure the flow of information on a regular and ongoing basis
    • Researches and responds to any escalated provider inquiries and requests in a timely, professional and informative manner.
    • Perform other duties as assigned by management

    EDUCATION REQUIRED

    • Bachelor’s Degree from an accredited college or university. Four to six years of equivalent experience will be considered in lieu of degree

    REQUIRED KSAS

    • Knowledge of EDI or similar Claims or Provider regulations and requirements.
    • At least 2 years of experience in a health care environment (i.e. healthcare facility, managed care setting, insurer, credentialing verification organization).
    • At least 2 years’ previous supervisory experience.
    • Knowledge of EDI policies and procedures.
    • Excellent organizational, written, and verbal communication skills
    • Ability to perform comfortably in a fast-paced, deadline-oriented work environment
    • Ability to work as a team member, as well as independently

    PREFERRED KSAS

    • Previous experience working with MassHealth providers.
    • Knowledge of the MassHealth program
    • Experience in a health care environment
    • Knowledge of EOHHS regulations and program highlights.
    • Understanding of provider billing practices and claim processing


    ADDITIONAL NOTES
    This position is a critical in processing health care provider’s file submissions and provider application updates.
    • Run daily status reports and ensure data quality in preparation for scrums (excel spreadsheets): Closed (yesterday, today, weekly, monthly), Enrollments, Queue, Duplicate Claims, Tech Refresh TPT, Claim Ops
    • Facilitate daily scrums with the goal of the team presenting status updates to EDI Manager
    • Scribe daily scrums, capture priorities set by EDI Manager and send email with recap to EDI team daily immediately after meetings
    • Follow-up with staff on progress made based on prioritized scrum list throughout the day
    • Ensure adequate coverage for the Daily Coverage Schedule (Phones, emails, enrollments, faxes, 999R Emails)
    • Mentor staff on best-practices of data integrity for MassServe status reports

     

    Essential Duties and Responsibilities:
    - Responsible for assigning day to day revalidation work items.
    - Monitor employee performance for compliance to established protocol (SLA).
    - Work closely with Quality Assurance (QA) and Documentation Management areas to ensure all providers are revalidated timely and accurately.
    - Facilitate the monthly revalidation launch process and monitor all mailings related to the revalidation monthly cycle.
    - Effectively lead coaches and train and counsel revalidation specialist.
    - Research and respond to any escalated provider inquiries and requests in a timely, professional and informative manner.
    - Produce weekly/monthly revalidation reports to be presented to staff.

    Minimum Requirements:
    - Associate degree or equivalent combination of education, technical training or work experience considered in lieu of degree.
    - Minimum of two (2) years of related experience.
    - Ensure compliance with company Wage & Hour policy, including ensuring non-exempt employees get the rest & meal breaks.
    - Comply with all company required policies, procedures and processes including but not limited to required training.
    - Provides immediate supervision to a unit or group of employees, assigning tasks, checking work at frequent intervals, and maintaining schedules.
    - A portion of time is normally spent performing individual tasks related to the unit or sub-unit.
    - Generally supervises semi-skilled employees or a few individual professional contributors.
    - Works on issues of limited scope.
    - Follows established practices and procedures in analyzing situations or data from which answers can be readily obtained.
    - Monitors daily operations of a unit or sub-unit.
    - Requires full knowledge of own area of functional responsibility.
    - Frequently interacts with subordinate employees and functional peer groups.
    - Interaction normally requires the ability to gain cooperation of others, conducting presentations concerning specific projects or schedules.
    - Receives predetermined work assignments that are subject to a moderate level of control and review.
    - Directs subordinates to complete assignments using established guidelines, procedures and policies.

    - Develop work schedules and assign duties to subordinates to ensure efficiency.
    - Evaluate subordinates' job performance and recommend appropriate personnel action.
    - Discuss job performance concerns with subordinates to identify causes and issues and works closely with the Human Capital department on resolving problems.
    - Identify training needs and development opportunities for subordinates.

     

    EEO Statement: Active military service members, their spouses, and veteran candidates often embody the core competencies MAXIMUS deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We’re proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you. A committed and diverse workforce is our most important resource. MAXIMUS is an Affirmative Action/Equal Opportunity Employer. MAXIMUS provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.

    Apply/Socialize

    Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
    Share on your newsfeed

    Need help finding the right job?

    We can recommend jobs specifically for you! Click here to get started.