Enrollment EDI, EFT, and ERA Specialist

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.

Job Summary:

The Enrollment EDI, EFT, and ERA Specialist is responsible for completing and managing all enrollment processes related to electronic claims submission and Electronic Remittance Advice (ERA). This role involves ensuring that providers are properly enrolled with payers and clearinghouses, maintaining accurate records, and managing the flow of claims and remittance data. The specialist will work with multiple Practice Management Systems (PMS) and clearinghouses, leveraging a solid understanding of payer requirements to complete enrollments efficiently and ensure timely payment processing.

Work Mode: Remote
Shift Timings: 6pm-3am (Night Shift)
Location: Mumbai (Vikhroli)

Responsibilities:

(Mandatory Qualifications & Skills):

Graduate in Any Field

Basic RCM knowledge

1-2 years Enrollment experience

Responsibilities:

EDI/ERA Enrollment

• Prepare and submit applications to configure EDI claims and ERA through clearinghouses and payer portals.
• Ensure providers are enrolled for electronic claim submission
• Handle enrollment, re-enrollment, and re-validation processes for providers and locations.

Data Management:

• Process, data entry, and file maintenance of enrollment, assessment, and dis-enrollment documentation.
• Monitor, compile, and maintain accurate enrollment records
• May also prepare and submit applications to configure Electronic Funds Transfer (EFT) with payers.
• Verify enrollment status, make changes to membership records, research and resolve enrollment system discrepancies, process membership terminations, and other forms of enrollment events.

Communication & Coordination:

• Serve as the primary point of contact for payer and clearinghouse inquiries regarding EDI, EFT, and ERA enrollments. Communicate effectively with internal teams to ensure smooth processing of claims and remittances.

Skills:

• EFT (Electronic Funds Transfer): Understanding of EFT setup and management processes. Ability to handle payment processing, troubleshooting payment issues, and ensuring accurate deposit posting.
• ERA (Electronic Remittance Advice): Experience with ERA processing, including remittance retrieval, interpretation, and accurate posting to patient accounts.
• Healthcare Billing Systems: Familiarity with medical billing and clearinghouse systems. Ability to navigate and configure payer systems for claim submissions and payment processing.

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