EDI & Claims Specialist — Revenue Cycle Detective

AleraCare Holdings, LLC; Sandy (UT); On-site; USD 33,000 - 39,000; Full time

Benefits offered by this job

Competitive hourly rate

401(k) Matching

Health, Vision, and Dental Insurance

Over 20 days of paid time off annually

One paid community service day each ye

community service day each year to"}],

EDS

Job summary

Pure Infusion is a fast-growing Utah healthcare company seeking an EDI Claim Specialist to own the claims lifecycle. You will submit electronic and paper claims, resolve rejections, and coordinate with billing, credentialing, and IT across multiple payers.

The role requires 2+ years in healthcare EDI, CPT/HCPCS and ICD-10 proficiency, HIPAA compliance, and strong communication with payer support. You’ll drive issue resolution and ensure timely reimbursement with data integrity.

Qualifications

• 2+ years of experience with EDI in a healthcare billing or RCM environment.
• Strong command of CPT/HCPCS and ICD-10, modifiers, units/NDC, and NCCI/MUE edits to read edits and identify causes.
• Proven ability to manage payer-specific EDI setup and escalations.
• Ability to ensure compliance with HIPAA EDI standards and internal RCM protocols.
• Excellent written and verbal communication, especially with payer tech support.

Responsibilities

• Submit electronic and paper claims within established filing limits.
• Investigate and resolve rejected claim center claims.
• Identify recurring denial trends and inform the appropriate teams.
• Collaborate with billing, intake, and other revenue cycle departments to resolve issues.
• Maintain patient confidentiality and comply with HIPAA and regulations.
• Meet productivity, quality, accuracy, and turnaround-time goals.
• Perform additional duties as assigned by supervisor or management team.

Skills

EDI experience

CPT/HCPCS knowledge

HIPAA compliance

Communication skills

Interdepartmental collaboration

Tools

AdvancedMD

Waystar

Job description

Pure Infusion is a fast-growing Utah healthcare company seeking an EDI Claim Specialist to own the claims lifecycle. You will submit electronic and paper claims, resolve rejections, and coordinate with billing, credentialing, and IT across multiple payers.

The role requires 2+ years in healthcare EDI, CPT/HCPCS and ICD-10 proficiency, HIPAA compliance, and strong communication with payer support. You’ll drive issue resolution and ensure timely reimbursement with data integrity.