EDI Specialist

Harris Computer; Mumbai; Hybrid; INR 900,000 - 1,500,000; Full time

Job summary

Resolv in Mumbai (Office Hybrid) seeks an experienced EDI Specialist to manage end-to-end healthcare EDI transactions and maintain payer relationships. You will onboard payers, ensure compliance, and resolve denials while coordinating with billing and EHR/PM systems.

A strong background in HIPAA, X12, and vendor management is required. The role focuses on improvement of revenue cycle operations, with responsibilities ranging from setup and testing to monitoring EDI folders and client termination

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.
• Coordinate with Clearinghouses and handle SFTP notifications and EDI105 issues.
• Patient statements setup and RCM client termination processes as needed.

Skills

Problem-solving

Communication

Vendor management

Analytical

Organized

Detail-oriented

Education

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

Tools

EDI systems

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!