EDI Enrollments Specialist
EDI Enrollments Specialist
EDI Enrollments Specialist
Candid Health
The EDI Enrollments Specialist role involves preparing and submitting applications for Electronic Data Interchange (EDI) claims and Electronic Funds Transfer (EFT) in a healthcare setting. The position requires strong communication skills, a background in revenue cycle management, and the ability to investigate and resolve enrollment issues. The role is focused on maintaining accurate records and meeting performance metrics while adhering to HIPAA guidelines.
Qualification
- At least 2 years of experience in revenue cycle management in healthcare/healthtech
- Experience with EDI enrollment preferred, Change Healthcare experience is a plus
- Investigative mindset with problem-solving skills based on data
- Self-starter with a high quality bar
- Excellent oral and written communication skills
- Effective multitasking skills
- Positive and cooperative attitude in communication with all levels of the organization
Responsibility
- Prepare and submit applications for EDI claims and ERA through clearinghouse and payer portals
- Configure Electronic Funds Transfer (EFT) with payers
- Investigate provider enrollment denials and errors with payers
- Review correspondence from payers and take appropriate action for resolution
- Act as a liaison between the RCM department and Strategy & Operations team to resolve enrollment tasks
- 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
- Adhere to HIPAA guidelines
