Fallon Health · 20 hours ago
EDI Coordinator
Worcester, MA
Full-time
Onsite
Mid Level
$75K/yr - $85K/yr
3+ years expFallon Health is a company that cares, prioritizing member needs and delivering high-quality, coordinated care. The EDI Coordinator plays a key role in facilitating the electronic flow of data, improving operations by increasing the volume of electronically submitted claims and ensuring compliance with HIPAA standards.
FitnessHealth CareMedical
No H1B
Responsibilities
Assist in testing new and updated technology applications to the current EDI logic and then communicating the results to appropriate departments
Assist in the implementation of the HIPAA transaction sets across the company (270/271, 276/277, 278, 820, 834, 835, 837I and 837P)
Leads the process of escalating the magnitude of providers who submit their claims to Fallon Health through electronic submission, including actively seeking new enrollees
Responsible for communicating with internal departments, as well as contracted providers, concerning submittal issues that require troubleshooting
Responsible for managing designated trading partner relationships
Tracks the incoming EDI file names, dates, claim counts, and fatal edits, including logged, run and process files to support timely and accurate reconciliation processes
Audits claims received via EDI to ensure accuracy
Seeks quality improvements for the EDI process
Support timely, accurate setup and activation of portal accounts for providers and employers
Qualification
Required
A Bachelor's Degree in Computer Information Systems discipline is highly desired, but we will also consider equivalent work experience
Three (3) years experience in the operational side of a Health Insurance Organization
EDI/Edifecs and/or QNXT experience desired
Extremely PC savvy
Strong knowledge and experience with the MS Office Suite of products required
Strong project leadership skills
Proven verbal and written communication skills
Adaptability
Analytical Ability
Perseverance
Problem Solving
Results Oriented
Ability to document all policies and procedures in a format that is understandable by various readers
Company
Fallon Health
Founded in 1977, Fallon Health is a community-focused not-for-profit health care services organization based in Worcester, Massachusetts.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Dorothy Vandette
Manager, CEO Office
Todd Bailey
Senior Vice President, Chief Financial Officer
Recent News
2026-01-09
2025-08-07
2025-06-07
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