EDI Payor Enrollment Rep

General Job Summary:

Responsible for establishing documents and maintains EDI procedures/processes.  Assists customers with electronic data interchange and resolves customer issues.  Reconciles EDI transactions through coordinating information between internal departments.  Works independently on EDI related issues and collaborates with internal members in constantly seeking improvements of XIFIN RCM solution system.

Essential Job Function:

·         Establishes, documents, and maintains EDI procedures/processes

·         Monitors daily EDI processes and performs troubleshooting

·         Ensures payor configurations are completed correctly and timely

·         Identifies optimal routing of EDI for quality and cost-saving

·         Coordinates activities with appropriate teams and other business partners for EDI projects

·         Understands technical EDI Implementation, Technical Reports, and payor companion guides

·         Updates Medicare/Medicaid CPT tables across all customers

·         Identifies and documents changes to NCDs, LCDs, Fee Schedules, and Reason tables

·         Other duties as assigned by management

Knowledge, Skills, and Abilities:

·         Solid experience with SQL, preferably in an Oracle environment

·         Understanding of healthcare industry and healthcare reimbursements in a transaction-intensive setting

·         Experience in identifying submission requirements for both electronic and paper formats

·         Ability to prioritize in a fast-paced, rapidly changing environment

·         Ability to analyze and formulate solutions to complex business and/or technical problems

·         Excellent written and oral communication skills

Education and Experience:

·         B.A./B.S. degree in IT, Computer Science, or related discipline or equivalent work experience

·         3+ years experience working in healthcare billing, A/R, or EMR systems

·         3+ years working with healthcare EDI X12

Work location: San Diego, CA