SUMMARY
The Client Services EDI Liaison will act as the liaison between the Client Services and Implementation Team with the Electronic Data Interchange (EDI) Team to ensure clients and their vendors are able to provide and receive electronic eligibility, claims, and accumulator files. They will drive the integration, mapping and ongoing support of application requirements while maintaining transparent project status communications. This position will partner with other Client Services Account Managers to execute plan benefit changes, facilitate account support and conduct detailed claims research. The position will work collaboratively with other central departments and stakeholders to solve complex problems, ensure all client deliverables are timely and accurate, and client needs are being met, to maintain client retention, renewal, and overall plan satisfaction.
ESSENTIAL DUTIES AND RESPONSIBILITIES include but are not limited to the following:
- Work directly with clients, data vendors and TPA’s for seamless integration.
- Coordinate collaborative meetings when needed with vendors and TPAs to ensure positive outcomes.
- Collaborate with cross-functional teams to represent client(s) internally and coordinate functions such as problem resolution, system implementations, project completion and/or to address ongoing pharmacy service needs.
- Take lead on data discrepancy issues when they arise to identify root cause and implement prevention measures.
- Support Client Services team members with data needs.
- Actively listen to identify nuances in client business needs
- Translate client needs into technical requirements
- Identify and define reporting requirements during client implementation
- Work with internal departments to ensure development of new requests is completed on schedule
- Manage and track data exchange vendors
- Provide ideas and suggestions to team for improved processes
- Assist with delivery and receiving of electronic transmissions, working cooperatively with others to support the EDI department.
- Develop maintenance documentation for all new deliverables that require ongoing support.
- Actively expand knowledge base in relevant EDI techniques to provide value to our business by enhancing self-knowledge and capability
- Research and assess technologies and collaborate with industry vendors.
- Review transaction logs to ensure all data transmissions occur smoothly and securely.
- Utilize various data and analytics tools to prepare reports, written and verbal communication, and/or presentations as needed.
- Perform administrative tasks associated with onboarding new EDI vendors.
- Assist with identifying and fixing failed transmissions, data mismatches, or network drops.
- Utilize critical thinking, and data analysis while optimizing cross-functional workflows.
- Configure communication channels to securely connect new suppliers, vendors, or clients.
- Support internal workflows and execute process enhancements to drive operational efficiency.
- Provide backend support for plan design and benefit configuration to the Client Services and Implementation team.
- Execute complex benefit setup and plan changes while providing technical guidance on system structures, ensuring accurate end-to-end implementation of all requests.
- Examine complex claims processing details and assist with corrective measures when necessary to ensure accurate adjudication.
- Conduct regular service/relationship communications with clients.
- Identify, research, resolve, and provide prompt follow-up to all service requests.
- Assist and coordinate system testing and quality assurance submissions.
- Develop and maintain a working knowledge of client's objectives, plan designs, and overall needs of clients.
- Maintain ProCareRx systems to ensure documentation of client communications and client information is updated and accurate; includes but not limited to; new addresses, client contacts, plan notes, and documentation.
- Communicate with Client Services leaders to provide consistent project assessments, feedback and task status updates,
- Assist leadership with project management tasks as needed.
- Other duties as assigned
QUALIFICTIONS AND REQUIREMENTS
- Associate degree with at least two years of relevant experience, or an equivalent combination of education and work experience.
- PBM or healthcare industry experience.
- Highly proficient in Microsoft Office suite and specialized industry software solutions.
- Ability to apply data analytics, logic, and critical thinking to resolve complex problems.
- Capable of performing effectively both independently and within a collaborative team environment.
- Exceptional customer service skills.
- Strong verbal and written communication competencies.
- Excellent time management and organizational abilities.
PHYSICAL DEMANDS
Requires sitting, standing, and occasional light lifting.
ProCare Rx will never ask for a financial commitment from an applicant as part of our recruitment process. All interviews are conducted in-person OR through video conference invitations from official company emails. For inquiries, please contact our official recruitment team at HumanResources@procarerx.com.
ProCare Rx is an Equal Opportunity Employer.