01Key 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.
Qualifications: Bachelors degree in IT, Healthcare, or related field. 57 years of healthcare EDI experience with RCM exposure. Knowledge of HIPAA, X12 transaction sets, and payer workflows. Strong problem-solving, communication, and vendor management skills.
Work Mode: Office Hybrid Shift Timings: 6pm-3am (Night Shift) Location: Mumbai(Vikhroli) Skills/ Behavioural Skills: Problem-Solver: Identifies and resolves healthcare billing discrepancies.
Organized: Manages high volumes of medical remittances efficiently.
Clear Communicator: Effectively discusses payment issues with healthcare teams.
Analytical: Understands healthcare financial data and denial patterns.
Benefits: Annual Public Holidays as applicable 30 days total leave per calendar year Mediclaim policy Lifestyle Rewards Program Group Term Life Insurance Gratuity .and more! .
