EDI Enrollments Specialist

Position Overview

• Location Type: Remote
• Employment Type: Contract
• Salary: $22 - $27 USD per hour (Estimated starting annual salary range)

This role involves configuring Electronic Data Interchange (EDI) claims and Electronic Remittance Advice (ERA) through clearinghouses and payer portals, as well as Electronic Funds Transfer (EFT) setups with payers. The position requires investigating payer enrollment denials and errors, reviewing payer correspondence, and acting on resolutions. It also involves acting as a liaison between the RCM department and Strategy & Operations, and maintaining accurate enrollment records within the Candid Health product.

Requirements

• Experience: At least 2 years of experience in revenue cycle management (for medical billing or within healthcare/healthtech).
• EDI Enrollment Experience: Experience with EDI enrollment is preferred.
• Change Healthcare Experience: Experience with Change Healthcare is a plus.
• Investigative Skills: An investigative mindset and the ability to run down problems and suggest actions based on data.
• Communication Skills: Excellent oral and written communication skills.
• Multitasking Skills: Effective multitasking skills.
• HIPAA Compliance: Knowledge and adherence to HIPAA guidelines.

Responsibilities

• Prepare and submit applications for EDI claims and ERA through clearinghouses and payer portals.
• Prepare and submit applications for EFT configurations with payers.
• Initiate investigations with payers regarding provider enrollment denials and errors.
• Review correspondence received from payers and take appropriate action for resolution.
• Work as a liaison between the RCM department and Strategy & Operations to discuss, investigate, and resolve enrollment tasks.
• Interact with customers through excellent written and verbal communication.
• Maintain up-to-date and accurate enrollment records within the Candid Health product.
• Meet and maintain KPIs/metrics for production and quality.
• Maintain working knowledge of workflow, systems, and tools used in the department.

Application Instructions

• (No specific application instructions were provided in the original job description.)

Company Information

• (No company information was provided in the original job description.)

Pay Transparency

• The estimated starting annual salary range for this position is $22-$27 USD per hour. The listed range is a guideline from Pave data, and the actual base salary may be modified based on factors including job-related skills, experience/qualifications, interview performance, market data, etc.