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EDI Representative

Date:  Jan 27, 2023

Anchorage, AK, US, 99503

Req ID:  11631

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at HMS, a Gainwell Company carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.


HMS, a Gainwell Technologies Company

HMS is hiring an EDI Representative who will be responsible for answering calls regarding EDI transaction processing. They must have the ability to review health care data in ANSI X12 and XML formats and assist providers/vendors in a call center setting with Electronic Data Interchange (EDI) resolution. They will also need to responsibly monitor POS/MEVS.

Your role in our mission

•    Coordinates the set up and approval of providers, clearinghouses, and billing agencies for the web portal, including the completion of agreements and transaction forms.
•    Validates, researches, and resolves daily EDI data received from providers, clearinghouses, and billing agencies.
•    Resolves problems related to specific EDI documents that generate 997, TA1, and 837 errors. Works with vendors/trading partners to identify, define, develop, and implement changes to correct errors.
•    Manages EDI projects and communicates directly with providers, clearinghouses, and billing agencies in a call center setting.
•    Reads, understands, and communicates, in a professional manner, Extensible Markup-language (XML) data and ANSI X12 format, including 835 and 837 Professional, Institutional, and Dental formats.
•    Assists providers with Direct Data Entry (DDE) submission of claims, retrieval of electronic remittance advices, and related reports on the NJMMIS web portal.
•    Balances HIPAA claims between the Web Server and the Mainframe environments daily.
•    Works with Providers/Submitters to test files and move from Test to Production Status for submitting transactions.
•    Performs analysis of 837 HIPAA files to identify and help resolve submitter’s errors.

What we’re looking for

•    Two to five years of Provider Call Center experience with EDI specific experience and knowledge preferred.
•    Excellent verbal and written communication skills; strong organizational skills, attention to detail, and problem solving and ability to perform tasks thoroughly and with a high degree of accuracy.
•    Working knowledge of Mainframe TSO (Time Sharing Option) and basic UNIX Commands and ability to use third-party software such as CLAREDI.
•    Ability to maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
•    Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customers.


What you should expect in this role

Work from an office in Anchorage, AK





The pay range for this position is $36,900.00 - $46,100.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at HMS, a Gainwell Company. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.


We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with HMS, a Gainwell Company, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about HMS, A Gainwell Technologies Company at our company website and visit our Careers site for all available job role openings.


HMS, a Gainwell Company is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.

Nearest Major Market: Alaska
Nearest Secondary Market: Anchorage

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