EDI Enrollment Rep

Position: EDI Enrollment Rep-550800

Are you interested in joining a team of experienced healthcare experts and have the ability to shape and transform the healthcare delivery system? At our family of companies, everything we do is to help improve the lives of the nearly 12 million Medicare beneficiaries we serve and 700,000 health care providers who care for them. It is our goal to help create a better health experience for all consumers.

Join our winning culture and help transform Medicare for the millions of people who rely on its services.

Benefits info:

• Medical, dental, vision, life and supplemental insurance plans effective the first day of the month following date of hire
• Short- and long-term disability benefits
• 401(k) plan with company match and immediate vesting
• Free telehealth benefits
• Free gym memberships
• Employee Incentive Plan
• Employee Assistance Program
• Rewards and Recognition Programs
• Paid Time Off and Paid Sick Leave

SUMMARY STATEMENT

Responsible for enrollment of Medicare and other Government Contract providers, vendors, billing services and clearinghouses for various Electronic Data Interchange (EDI) products and services to set up organizations for electronic billing and portals. This includes database management, inventory control and phone contact to the EDI community to meet CMS requirements. Also provides administrative support for the staff to promote the enrollment, authorization, testing, and servicing of electronic billers.

ESSENTIAL

RESPONSIBILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This list of essential job functions is not exhaustive and may be supplemented as necessary.

Process EDI enrollment forms and faxes accurately and timely for all new and existing electronic billers: (40%)

• Log, validate and process EDI enrollment forms for electronic billing from providers, billing services, clearinghouses, and vendors. Ensure accuracy and completeness in accordance with Medicare and company policy and procedures. This requires accessing and reviewing the EDI Database and the Medicare claims processing systems to determine relevant profile information, establishing cases in the appropriate tracking systems, determining the need for EDI testing, and verifying Medicare authorization to bill electronically.
• Enroll users in the Medicare-offered free billing software.
• Enroll users for Electronic Remittance Advice (ERA) and other value- added EDI products and services.
• Enroll organizations into the Portals, process User  requests.

Maintain the EDI Submitter, EDI Vendor, and Tracking Databases: (40%)

• Update the databases accurately to ensure all customer data is accurate and detailed for integrity and statistical reporting purposes.

Communicate effectively. This position displays effective communication skills while performing the following functions: (10%)

• Interface with provider offices, vendors, clearinghouses and billing services on EDI issues and give input on EDI enrollment or submitter criteria modifications.
• Interface with EDI staff regarding the EDI enrollment process.

Complete EDI support calls concerning the EDI/Portal enrollment processes: (5%)

• Assists organizations in the enrollment process and provide status on the various enrollment forms submitted by customers.
• Contact providers, vendors, billing services, or clearinghouses to review errors and explain correction procedures. Log call information into tracking systems for provider notification purposes.

Perform other duties and assignments in support of the goals and objectives of Novitas Solutions, Inc., and EDI Services, as directed. This includes, but is not limited to, various administration tasks for the department including mail and imaging functions.

(5%)

Performs other duties as the supervisor may, from time to time, deem necessary.

REQUIRED QUALIFICATIONS

• High School Diploma or GED
• 1 year of experience working on a PC in a Microsoft Windows or similar environment
• Data entry experience
• Demonstrated oral, written and interpersonal skills
• Demonstrated organizational skills
• Demonstrated problem solving and research skills

PREFERRED QUALIFICATIONS

• Demonstrated knowledge of Medicare EDI control logic, the telecommunications platform, types of electronic billing formats, and connection protocol concepts.
• Demonstrated knowledge of Medicare EDI controls and security processes.
• Demonstrated understanding of all possible EDI…