EDI Specialist

Key Responsibilities: 

• Manage end-to-end EDI transactions (837, 835, 270/271, 276/277, 278) for claims and remittances. 

• Onboard and manage payers and clearinghouses; ensure EDI compliance and testing. 

• Analyze and resolve transaction errors, rejections, and denials. 

• Oversee EDI integration with billing and EHR/PM systems.

• EDI profiles understanding data elements, segments, and loops within an EDI file are structured and interpreted. 

• Setting up new clients

• Insurance Master Import. EDI configuration setup (SFTP and BIZUDS).

• SFTP notifications (SFTP blocking). Monitoring EDI folders for pending files.

• Billing Sanity check for Upgraded/shifted RCM Clients. Claims (EDI837/837i) related issue.

• Eligibility Issues (EDI270 and EDI271). Acknowledgements EDI997 and EDI277 Issues.

• Remittances EDI835 issue and resolution.

• Resolution on Rejections and Denial issues.

• Coordination with Clearinghouses.

• Patient Statement Setup.

• Resolv RCM Client Termination Process.

• Coordinate with the engineering team regarding problems and enhancements.

• Miscellaneous Activities.