EDI/MCO Claims Adjudicator Manager

US-UT-Salt Lake City
Job ID
# of Openings
Information Technology


We are looking for a Assistant EDI/MCO Claims Adjudicator will support the day to day operations of EDI, including identifying any technical problems with sending/receiving transactions. Someone who demonstrates human relations and effective communication skills between different departments.
 If you strive for nothing but excellence, this team is for YOU!


 Location:  3900 South 1190 East, Ste. A150, Salt Lake City, UT  84124


Schedule:  M-F; 8:00 am – 5:00 pm


Pay: Commensurate with experience


Benefits:   Yes…Valley provides a generous benefits package including Health and Dental insurance, Paid time off, paid holidays, health savings plan, Employee assistance program, tuition reimbursement, 401K and Roth IRA and Long and Short-Term Disability. 



  • Support the day-to-day operations of EDI, including identifying any technical problems with sending/receiving transactions.
    • Generate 837 claim files using EHR system.
    • Work with EDI transmission system contractor to ensure all 837 claim files sent out to appropriate payers (Medicare, Medicaid FFS, Optum, Salt Lake County and Commercial insurance).
    • Check incoming 999 and 277CA transactions for 837 rejections.
      • Fix rejected 837 files or claims, as needed, and resend when necessary.
    • Submit ASCX12 (HIPAA) transactions to valuator, Claredi Classic, for HIPAA errors.
  • Work with payers and contractors for testing of any HIPAA EDI file transactions and program changes.
  • Work with billing staff and programmers on any updates or corrections to EHR systems or EDI transactions.
  • Represent Valley Behavioral Health on UHIN (Utah Health Information Network) Standards Committee, including subcommittees, and ASC X12N (Accredited Standards Committee X12 - Insurance) as back up to EDI Specialist.
    • Help write and approve all UHIN Standards and Specifications.
    • Participate in meetings and calls to create and approve all National Standards for HIPAA transactions.
    • Keep informed on all Federal and Utah State laws and mandates.
  • Work with staff and payers on new programs or contract set ups, to ensure all services can be billed and paid.
  • Answer questions on EHR system, EDI billing and federal regulations for staff.
  • Work with staff and programmers on MCO adjudication systems (Valley Behavioral Health is the Mental Health Managed Care Organization for Summit and Tooele counties in Utah) for issues and updates.
  • Work with MCO providers to set up EDI transactions and testing.


  • 2+ years’ experience and/or education in EDI transactions (HIPAA/ASCX12).
  • 2+ years’ experience and /or education in adjudication of healthcare claims.
  • Ability to monitor
  • Demonstrate human relations and effective communication skills.
  • Excellent computer skills.
  • Follows all organization policies and procedures.
  • Meets required productivity standards, if applicable, and other organizational expectations.

We’re known for helping those we serve lead more fulfilling lives. That’s the focus of what we do, but we are much more. We’re a growing and evolving organization that focuses on its people. At our core, we are a people powered organization. Our employees and our culture define us.


Let us be the best place you’ve ever worked.


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