EDI Specialist

Harris Global Business Services (GBS); Mumbai; Hybrid; INR 900,000 - 1,300,000; Full time

Benefits offered by this job

Annual Public Holidays

30 days total leave per calendar year

Mediclaim policy

Lifestyle Rewards Program

Group Term Life Insurance

Gratuity

...and more!

Job summary

Resolv seeks an experienced EDI specialist in Mumbai to manage end-to-end EDI transactions for healthcare claims and remittances. You will onboard payers and clearinghouses, ensure compliance and testing, and resolve denials and errors within EHR/PM integrations.

Role requires 5-7 years of healthcare EDI experience with RCM exposure, knowledge of HIPAA and X12, and strong vendor management and communication skills. Office hybrid with night shifts in Mumbai.

Qualifications

• Bachelor's degree in IT, Healthcare, or related field.
• 5-7 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.

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.

Skills

Problem-Solver

Organized

Clear Communicator

Analytical

Education

Bachelor's degree in IT, Healthcare, or related field

Job description

Business Unit

Resolv was formed in 2022, bringing together a suite of industry-leading healthcare revenue cycle leaders with over 30 years of industry expertise, including Ultimate Billing, First Pacific Corporation, Innovative Healthcare Systems, and Innovative Medical Management. Our DNA is rooted in revenue cycle solutions. As we continue to expand, we remain dedicated to partnering with RCM companies that offer diverse solutions and address today's most pressing healthcare reimbursement and revenue cycle operations complexities. Together, we improve financial performance and patient experience, helping to build sustainable healthcare businesses.

Business Unit

Resolv was formed in 2022, bringing together a suite of industry-leading healthcare revenue cycle leaders with over 30 years of industry expertise, including Ultimate Billing, First Pacific Corporation, Innovative Healthcare Systems, and Innovative Medical Management. Our DNA is rooted in revenue cycle solutions. As we continue to expand, we remain dedicated to partnering with RCM companies that offer diverse solutions and address today's most pressing healthcare reimbursement and revenue cycle operations complexities. Together, we improve financial performance and patient experience, helping to build sustainable healthcare businesses.

Key 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

• Bachelor's degree in IT, Healthcare, or related field.
• 5-7 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!