Senior EDI Coordinator

Fallon Health

. Oversee the company’s EDI process, including tracking incoming and outgoing EDI files .

Posted 9/15/2026full-timeWorcester • Massachusetts • United StatesSeniorWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in EDI processes, including implementation of HIPAA transaction sets and troubleshooting electronic claims submissions. Proven ability to lead projects, train staff, and enhance operational efficiency within a Managed Care Organization.

Highest-signal resume keywords

EDI ExperienceQNXT ExperienceProject Leadership SkillsBasic SQL SkillsMS Office Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

EDI Process ManagementHIPAA Transaction Sets ImplementationRegression TestingSNIP Level ValidationClaims ReconciliationTroubleshootingData TrackingElectronic Claims SubmissionQuality ImprovementProvider Training

Soft Skills

Verbal CommunicationWritten Communication

Tools & Technologies

BiztalkKEA Scripting SoftwareEdifecsQNXT System

Industry Keywords

Managed Care OrganizationElectronic SubmissionProvider ToolsEmployer ToolsClearinghouse Vendors

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

Oversee the company’s EDI process, including tracking incoming and outgoing EDI files
Monitor and research unsuccessful transmissions, recognize patterns, and contact appropriate parties to resolve issues
Handle provider concerns regarding submission discrepancies
Lead efforts to increase contracted provider use of electronic submission
Train and develop EDI staff and other department members as needed
Document new EDI procedures, policies, and processes
Liaise with IT, Configuration, internal departments, external customers, and EDI Coordinators for day-to-day questions and issue resolution
Implement HIPAA transaction sets across the company, including 270/271, 276/277, 278, 820, 835, 837I, and 837P
Represent the EDI Team in meetings with internal and external customers
Set up security for online tools, including Provider Tools and Employer Tools
Run KEA scripting software for Weight Watchers claims
Provide weekly updates on Trading Partners in testing phases
Test Edifecs and QNXT system upgrades or changes related to electronic submission
Test new and updated technology applications against current EDI logic and communicate results to appropriate departments
Escalate and expand provider electronic claims submission to maximize Fallon Health’s EDI rate
Increase the auto-adjudication rate of EDI claims according to annual strategic objectives
Manage communications concerning submission issues requiring troubleshooting
Administer relationships with clearinghouse vendors
Track EDI file names, dates, claim counts, fatal edits, and file processing status
Seek quality improvements for the EDI process
Oversee and monitor claims reconciliation for EDI claim submissions

Requirements

What you’ll need

Bachelor’s Degree required
Master’s degree or foreign equivalent in Electrical/Electronic Engineering, Electrical Power Systems, Computer Science, Engineering, or a related field and two (2) years of experience as a Software Engineer or a related occupation preferred
If education major is in other than preferred, then 4-7 years’ experience in the operational side of a Managed Care Organization or 2+ years of experience with preferred degree
QNXT experience a must
Extremely PC savvy
Strong knowledge of MS Office required
Internet experience
Biztalk experience
Strong project leadership skills
Proven verbal and written communication skills
EDI experience required, including regression testing and SNIP level validation
Basic SQL skills required for troubleshooting and validating issues

Benefits

Comp & perks

Equal employment opportunities and protection from discrimination and harassment
Opportunity to participate in Fallon Health’s Talent Community