Paramount Dental offers insurance products in Indiana, Kentucky and Ohio and pays claims in all 50 states. This Ohio- and Indiana-based company has been specializing in providing dental benefits to individuals since 1988.

Paramount Dental offers dental and vision plans to businesses of all sizes, participates in the Marketplace Exchange, and serves thousands of Medicare members through partnerships with health plans throughout the United States. The company, originally founded by dentists, focuses on providing its clients with products that work to improve their overall health.

As a part of ProMedica, Paramount Dental is driven by ProMedica’s mission to improve your health and well-being. ProMedica has been nationally recognized for its advocacy programs and efforts to address social determinants of health. Paramount Dental strives to provide an exceptional experience to every member.

REPORTING RELATIONSHIPS/SUPERVISORY RESPONSIBILITIES

This position reports directly to the Manager of Operations for Paramount Dental and may have indirect reporting to the Manager of IT Services at Paramount Dental and Manager of EDI Services for Paramount Health Care/ProMedica IT Services.

POSITION SUMMARY

The EDI and Vision Plan Specialist for Paramount Dental coordinates and executes all employer client and member Dental Vision Administration and Electronic Data Interchange (EDI) processes for the organization to achieve strategic and operational goals through growth initiatives, regulatory compliance, and system integration. This position collaborates with the Paramount Dental leadership team and business areas to ensure timely and accurate delivery of electronic data to best serve our Patients/Members, Providers, and Employer Clients. This position may interact/collaborate with external partners including vision plans, third-party vendors (clearing houses, data exchange partners, employer clients, etc.).

ACCOUNTABILITIES

1. Establish, maintain, and process all net-new and existing client EDI connections and file transfers to support business needs. Identify data gaps and manage remediation for all EDI files. a. EDI tasks/duties for this role will include but not be limited to the following processes that need to be maintained and or established: i. Eligibility requirements (EDI 270/271)

ii. Claims (EDI 837)

iii. Authorizations (EDI 820)

iv. Benefit enrollments (EDI 834)

v. Acknowledgments (EDI 834)

vi. Payment remittances (EDI 835)

2. Responsible for EDI processes and documentation that support daily business functions.

3. Apply knowledge of medical, dental, vision, and/or, encounters, and enrollments/eligibility file processing.

4. Apply knowledge of HIPAA transaction guides, data elements, and user requirements.

5. Assist in the development/creation/documentation of data mapping for all HIPAA/proprietary transactions and participate in QA (Quality Assurance) of mapping/translations before the release of EDI file processes in production.

6. Conduct research using a variety of SQL, XML, EDI, and file editing tools such as Microsoft SQL, etc.

7. Assist data and report analysts in developing data validation routines, building discrepancy reports, etc. for EDI files (including but not limited to claims, enrollment files for clients, etc.).

8. Acts as primary liaison between Claims/Encounter, Enrollment/Eligibility, and Customer/client production personnel.

a. Support mapping processes from a database using HIPAA Compliant Implementation Guide (IG) and Customer Companion Guide (CG) Transaction documentation and/or other proprietary formats to meet Customer/client requirements, as well as all associated documentation.

b. Companion Guides: Demonstrate and apply knowledge of state and federally mandated Companion Guide guidelines and their use. Conducts/updates/manages analyses and documents transaction requirements based on Implementation Guide, Companion Guides, and proprietary format instructions.

a. Applies to current Vision partnerships with Davis Vision and EyeMed (responsibilities list subject to any new future partnerships).

b. New employer group set-up and maintenance to Vision group accounts after sales process is complete (including but not limited to: sales support, employer benefit administrator interaction, completing all necessary account set-up paperwork/configuration within CORE, billing/invoicing, member/employer plan materials/communication creation and distribution.).

c. Creation, testing, troubleshooting, and consistent processing of Vision enrollment files for all vision employer clients and associated members.

d. Reference “steps/process” section Davis Vision and EyeMed desk level procedures for full list of processes and accountabilities.
Other duties as assigned.

This position can be worked remote

REQUIRED QUALIFICATIONS

Education: Associate degree in Computer Science, Management Information Systems, or other computer or business related field

Experience: 1-3 years of experience (transactional experience, client service, working with data, processes, and logistics).

Skills:

1. Excellent analytical and problem-solving skills.

2. Excellent listening, communication, and interpersonal skills.

3. Ability to effectively prioritize and execute tasks in a fast-paced environment.

Years of Experience: 1-3 years healthcare industry and/or quantitative work experience.

License: N/A

Certification: N/A

PREFERRED QUALIFICATIONS

Education: Bachelor’s Degree in Computer Science, Management Information Systems, or other computer or business-related field.

Experience: Experience with EDI technologies, processes, and logistics are highly beneficial.

Skills:

• 3-5 years of knowledge/experience of health/dental insurance, healthcare industry, and understanding of EDI 834, 835, and 837 generation/maintenance/exchange.

• 5-7 years of experience with healthcare EDI technologies, processes, and logistics.

License: N/A

Certification: N/A

WORKING CONDITIONS

Personal Protective Equipment: N/A

Physical Demands: N/A

Salary Range: $44,200 - $90,516

The above list of accountabilities is intended to describe the general nature and level of work performed by the incumbent; it should not be considered exhaustive.

ProMedica is a mission-based, not-for-profit integrated healthcare organizational headquartered in Toledo, Ohio. For more information, please visit www.promedica.org/about-promedica

Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact employment@promedica.org

Equal Opportunity Employer/Drug-Free Workplace