Assistant Manager EDI Enrollment & Credentialing

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Welcome to ModuleMD

At ModuleMD, we specialize in cloud-based EHR and Practice Management solutions for specialty healthcare providers. We’re on a mission to revolutionize revenue cycle management through AI, and we’re looking for innovators who are ready to help us shape the future.

Our Culture & Values

"We foster a culture of inclusivity, innovation, and integrity. Our team values collaboration, continuous improvement, and a passion for excellence."

Profile Overview

We are seeking a detail-oriented and proactive client-focused Assistant Manager – EDI Enrollment & Credentialing to join our team to oversee the enrollment of healthcare providers in TriZetto’s electronic transaction services, including EDI claims, ERA, and RTE. The role involves guiding clients through the end-to-end enrollment process, ensuring compliance, accuracy, and seamless onboarding while collaborating with internal and external stakeholders and also to ensure efficient and accurate enrollment processes, leveraging TriZetto’s STEM portal and other tools to streamline revenue cycle management and enhance client satisfaction.

Role Purpose:What You’ll Be Doing

• Client Onboarding: Guide doctors and medical practices through the enrollment process for TriZetto’s electronic transaction services, including EDI claims, ERA, and RTE.
• Payer Verification: Utilize TriZetto’s Gateway EDI Payer List to verify payer availability for requested services and confirm enrollment requirements.
• STEM Portal Management: Assist clients in submitting enrollment requests through TriZetto’s STEM portal, ensuring accurate data entry and timely submission of required documentation.
• Documentation Coordination: Collect, verify, and submit necessary documentation for payer enrollments, following up on requests and maintaining real-time status updates in the STEM portal.
• Client Support: Provide technical assistance and training to clients on navigating TriZetto’s systems, addressing inquiries about enrollment processes, payer requirements, and transaction setup.
• Compliance and Accuracy: Ensure all enrollments comply with payer-specific requirements and TriZetto’s standards to prevent delays in claims processing or payment.
• Collaboration: Work closely with internal teams (e.g., billing, IT, and customer support) and external stakeholders (e.g., payers and clearinghouses) to resolve enrollment issues and optimize workflows.
• Process Improvement: Identify opportunities to streamline onboarding processes, reduce enrollment timelines, and enhance client experiences based on feedback and industry best practices.
• Reporting: Maintain accurate records of enrollment statuses, generate reports on onboarding progress, and provide updates to management and clients as needed.

Must-Have Skills:

• 4-6 years of experience in healthcare provider enrollment, credentialing, or EDI/ERA/claims onboarding (experience with TriZetto is highly preferred)
• Strong understanding of payer enrollment requirements and healthcare transaction standards.
• Proficiency in working with TriZetto systems, particularly the STEM portal.
• Hands-on experience with TriZetto’s platforms (e.g., STEM portal, Facets, or QNXT) or similar clearinghouse systems (e.g., Waystar, Availity) is highly preferred.
• Familiarity with payer enrollment processes and electronic transaction setups (EDI, ERA, RTE).
• Experience with Medicare credentialing and PECOS (Provider Enrollment, Chain, and Ownership System).
• Knowledge of healthcare compliance standards, including HIPAA and payer-specific regulations.
• Prior experience in a client-facing role, providing training or technical support.

Nice-to-Have Certifications:

Certifications: Certified Patient Account Representative (CPAR) or similar credentials are a plus.

Technical Knowledge: Familiarity with TriZetto’s payer list, enrollment portals, and integration with practice management systems.

Required Qualifications

• Education: Bachelor’s degree in healthcare administration, business, or a related field preferred; high school diploma or equivalent required.
• Strong understanding of healthcare payer systems and electronic transaction workflows.
• Excellent communication and interpersonal skills to interact with clients and payers.
• Proficiency in Microsoft Office (Excel, Word, Outlook) and EHR/EMR systems.
• Detail-oriented with strong organizational and problem-solving skills.
• Ability to multitask in a fast-paced environment and meet deadlines.

Why Join ModuleMD?

• You’ll work at the intersection of AI and healthcare—real-world impact every day.
• Opportunity to work on cutting-edge healthcare technology and onboarding processes.
• Join a tight-knit, mission-driven team that values curiosity, autonomy, and innovation.
• Flexible work environment and a culture of continuous learning.

Application Process:

Equal Opportunity Statement

Ready to Join the Future of Healthcare AI?

Apply now with your GitHub/portfolio link and CV.