Specialist, EDI Enrollment

Responsibilities

• Process electronic enrollment applications for dental providers with insurance companies.
• Ensure accurate and timely submission of enrollment forms, claims, and other necessary documentation to insurance carriers.
• Verify and maintain accurate provider information in the EDI system to ensure smooth claims and payment processing.
• Troubleshoot and resolve EDI transaction issues, including eligibility verification and claim rejections.
• Provide support to dental offices with EDI enrollment and claims processing questions or issues.
• Maintain and update provider data.
• Monitor EDI transactions to ensure compliance with industry standards and insurance company requirements.
• Aid onboarding of new dental offices, ensuring they are properly set up in the EDI system.
• Coordinate with internal teams to ensure smooth workflow between the EDI system, claims processing, and provider support teams.
• Ensure all documentation is compliant with HIPAA and other relevant regulations to maintain confidentiality and security of patient data.
• Other duties and responsibilities as assigned.

Qualifications

• Equivalent to high school diploma or general education (GED).
• 2+ years of experience in revenue cycle management.
• Experience in testing and troubleshooting EDI systems and applications.
• Preferred Associate’s degree in related field of study from an accredited college or university.
• Experience in revenue cycle management within healthcare, dental, medical or retail.
• Experience with EDI enrollment.
• Knowledge of and ability to ensure compliance with HIPAA and other guidelines and regulations.
• Proficiency using clearinghouse portals for EDI transactions.
• Ability to investigate and resolve enrollment issues with payers.
• Demonstrated effective interpersonal, verbal and written communication skills to interact with various departments and external stakeholders.
• Ability to effectively multitask to manage multiple enrollment tasks simultaneously.
• Detailed-oriented with a high level of accuracy in maintaining enrollment records and processing applications.
• Ability to manage projects and programs related to EDI enrollment.
• Ability to effectively collaborate, work independently, and as part of a team with internal and external partners.