Specialist, EDI Enrollment

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Role Overview

The Specialist, EDI Enrollment processes the electronic enrollments for dental providers and insurance payers. The role ensures dental offices and insurance companies are properly set up in the Electronic Data Interchange (EDI) system for seamless claims submission, eligibility verification, and payment processing. The specialist ensures all required documentation is submitted accurately and timely to avoid delays or rejections in processing. The Specialist, EDI Enrollment ensures system functionality and compliance with industry standards. The role maintains and updates provider data, and supports providers with enrollment queries.

Responsibilities

1. Process electronic enrollment applications for dental providers with insurance companies.
2. Ensure accurate and timely submission of enrollment forms, claims, and other necessary documentation to insurance carriers.
3. Verify and maintain accurate provider information in the EDI system to ensure smooth claims and payment processing.
4. Troubleshoot and resolve EDI transaction issues, including eligibility verification and claim rejections.
5. Provide support to dental offices with EDI enrollment and claims processing questions or issues.
6. Monitor EDI transactions to ensure compliance with industry standards and insurance company requirements.
7. Assist onboarding new dental offices, ensuring they are properly set up in the EDI system.
8. Work closely with insurance payers to resolve claims and provider enrollment discrepancies or issues.
9. Generate and review reports to track enrollment status and claims processing, identifying areas for improvement or potential issues.
10. Coordinate with internal teams to ensure smooth workflow between the EDI system, claims processing, and provider support teams.
11. Ensure all documentation is compliant with HIPAA and other relevant regulations to maintain confidentiality and security of patient data.
12. 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/Skills/Abilities

• Ability to stay informed and maintain up-to-date knowledge of changes in EDI regulations and insurance company's policies and requirements.
• Familiarity with healthcare claims processing, electronic remittance advice (ERA), and electronic funds transfer (EFT).
• 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.

Benefits

• Medical, dental, and vision insurance
• Paid time off
• Tuition Reimbursement
• 401K
• Paid time to volunteer in your local community

Compensation Information $20.50-$26.70 / Hourly

Pds Health is an Equal Opportunity Employer. We celebrate diversity and are united in our mission to create healthier and happier team members.