EDI Enrollment Specialist (Medical Billing)

Our office specializes in Revenue Recycle Management, as well as Enrollment and Credentialing Services, for behavioral health providers. We support mission-oriented companies that impact the lives of thousands of individuals with autism and their families. We are excited to offer the opportunity for professional and collaborative individuals to be a part of a growth-oriented business.

As an EDI Enrollment Specialist, you will be responsible for Government and Commercial payer enrollment. This position covers initial enrollment for new payers with the clearinghouse, CAQH application monitoring services as well as revalidation enrollment when needed. You will be working directly with providers and the clearinghouse (Waystar, Availity, Steadi etc..), insurance representatives, CAQH and our clients for enrollments as well as troubleshooting any enrollment issues that arise.

Main Responsibilities:

• Is responsible for electronic data interchange (EDI) processes related to Behavioral Health/Medical billing enrollment ensuring the accuracy of data during the submission process.
• You'll prepare and submit applications to configure Electronic Data Interchange (EDI) claims and Electronic Remittance Advice (ERA) through clearinghouse and other payer portals
• You'll prepare and submit applications to configure Electronic Funds Transfer (EFT) with payers
• Review all payments being received to identify all payers that EDI, ERA and EFT can be processed through our clearinghouse.
• Communicate with our clearinghouse on any enrollment issues.
• You will review provider enrollment denials and errors with payers to resolve denial issue in a timely manner. This includes working directly with the payers and providers.
• You will partner with the Billing Implementation team and Director, RCM Operations to enroll new payers/providers to resolve enrollment tasks
• You will maintain accurate enrollment records and provide updates to Management and Clients as needed
• You will document and maintain process workflows, systems configuration, and tools used in the department.
• You must adhere to and follow all HIPAA guidelines
• You will be assigned special projects as needed

Required Skills and Knowledge:

• You have at least 2 years of experience in revenue cycle management (for medical billing or behavioral health billing)
• You have experience with EDI enrollment including the enrollment of payers with clearing houses such as Availity, Waystar and Stedi.
• You are familiar with EDI file formats (such as 834 transactions) and experience with EDI software and systems are essential.
• Experience with CredentialStream is a plus
• You are a self-starter comfortable working with Clients and Vendors to resolve issues in a timely manner.
• You must have excellent oral and written communication skills
• You are effective at multitasking and can demonstrate the ability to work with multiple clients at the same time.
• You possess the ability to communicate with individuals at all levels of the organization

Benefits: 

• PTO and Vacation Days after a 90-day introductory period 

• Paid Holidays 

• Generous Health, Denial & Vision benefits package 

• 401k + Matching 
   

Job Type: Full-time, Monday-Friday (8-5 PM) 

Remote opportunities are available only in the following states: AL, AR, AZ, CA, CO, FL, GA, ID, IL, IN, IA, MO, NC, NE, NY, OH, PA, SC, TN, TX, UT, VA

Our commitment to an inclusive workplace 

RethinkFirst is an equal opportunity employer and is committed to providing a workplace free from harassment and discrimination. We celebrate the unique differences of our employees because that is what drives curiosity, innovation, and the success of our business. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, gender identity or expression, age, marital status, veteran status, disability status, pregnancy, parental status, genetic information, political affiliation, or any other status protected by the laws or regulations in the locations where we operate. Accommodations are available for applicants with disabilities. 

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