Hybrid Payer Operations & Intelligence Specialist

Quadax; Middleburg Heights (OH); On-site; USD 45,000 - 60,000; Full time

Job summary

Quadax in Middleburg Heights, OH is seeking a Payer Operations & Intelligence Specialist. This full-time, hybrid role focuses on optimizing payer EDI transactions, insurance plan structures, and workflows across the Revenue Cycle Services division to improve reimbursement efficiency and regulatory alignment.

You will collaborate with Client Engagement, Operations, the EDI division, Product Management, Marketing, and external stakeholders.

Qualifications

• Associate degree in healthcare administration or equivalent.
• Experience in healthcare revenue cycle, insurance billing, or EDI preferred.
• Proficient with Microsoft Excel and Word.
• Experience managing multiple complex projects in a fast-paced environment.
• Ability to exercise independent judgment.

Responsibilities

• Independently manage and oversee provider EDI enrollment for electronic claims, remittance, and eligibility for clients.
• Analyze and maintain insurance plan configurations, including eligibility logic and claim workflows.
• Evaluate and communicate changes to payer requirements to stakeholders clearly.
• Investigate and resolve complex transactional issues related to claims, remittance, eligibility, and status.
• Identify opportunities to improve workflows and reimbursement outcomes with data-driven analysis.
• Validate daily claim and remittance processing against established controls.
• Maintain electronic eligibility verification services and plan code mappings.
• Provide SME guidance on EDI transactions (270/271, 837, 835) to clients.
• Represent the RCS division in Insurance Committee meetings and cross-functional meetings.
• Other duties as assigned.

Skills

Analytical thinking

Communication skills

Cross-functional collaboration

Attention to detail

Education

Associate degree in healthcare administration

Bachelor's degree preferred

Tools

Microsoft Excel

Microsoft Word

Job description

Quadax in Middleburg Heights, OH is seeking a Payer Operations & Intelligence Specialist. This full-time, hybrid role focuses on optimizing payer EDI transactions, insurance plan structures, and workflows across the Revenue Cycle Services division to improve reimbursement efficiency and regulatory alignment.

You will collaborate with Client Engagement, Operations, the EDI division, Product Management, Marketing, and external stakeholders.