EDI Enrollment Specialist

Ventra Health

2 - 5 years

3 - 7 Lacs

chennai

Posted:None| Platform:

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Skills Required

ansi x2 as2 access administration us healthcare vlookup healthcare sql operations b2b denial management xml x12 medical billing rcm powerpoint edifact pivot table edi sterling integrator excel claims processing ar calling word revenue cycle management ms office

Work Mode

Work from Office

Job Type

Full Time

Job Description

Overview

The EDI Enrollment Specialist is responsible for the setup, verification, and maintenance of provider and facility enrollments in clearinghouses (e.g., Athena, PhiCure) for electronic claims (EDI), remittance advice (ERA), and electronic fund transfers (EFT). This role ensures accurate enrollment tracking, monitors pending approvals and signatures, and resolves enrollment-related escalations, such as missing ERA remits or rejected EDI claims.

Responsibilities

Set up new facility and provider enrollments in clearinghouses (Athena, PhiCure).
Process new EDI enrollments to enable claims submission.
Enroll providers in ERA to replace paper EOBs with electronic remittance advices.
Enroll providers in EFT for direct deposit payments.
Verify successful enrollment for claims, ERAs, and EFTs.
Track, research, and confirm file transmissions to clearinghouses and payers.
Troubleshoot failed transmissions and claim edit issues.
Manage pending payor approvals and signatures.
Address issues such as unexpected paper checks, incorrect payments, or EDI rejections.
Collaborate with internal teams on escalations.
Perform special projects and other duties as assigned.

Qualifications

High School Diploma or GED required.
Experience in healthcare access administration, medical billing operations, or healthcare IT support.

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