[Hiring] EDI Enrollment Representative @GuideWell Source

Role Description

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

• 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.
  • Access and review the EDI Database and the Medicare claims processing systems to determine relevant profile information.
  • Establish cases in the appropriate tracking systems.
  • Determine the need for EDI testing and verify 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 and process User ID role 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.
  • 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%)
  • Assist 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: (5%)
  • This includes various administration tasks for the department including mail and imaging functions.

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 billing arrangements and systems structures.

Requirements

• The Federal Government and the Centers for Medicare & Medicaid Services (CMS) may require applicants to have lived in the United States for a minimum of three (3) years out of the last five (5) years to be employed with the Company.
• Background Investigation: If selected for this position, you must undergo a pre-employment Background Investigation, Drug Screen, and Identity Proofing documentation must be cleared prior to hire.
• Identity Documentation: You must have access to a current and unrestricted REAL ID, U.S. Passport, U.S. Passport Card, Foreign Passport, or U.S. Permanent Residency Documents.

Benefits

• 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

Company Description

We are an Equal Opportunity/Protected Veteran/Disabled Employer.

This opportunity is open to remote work in the following approved states: AL, FL, GA, ID, IN, IO, KS, LA, MS, NE, NC, ND, OH, PA, SC, TN, TX, UT, WV, WI, WY. Specific counties and cities within these states may require additional approval. In FL and PA in-office and hybrid work may also be available.