EDI Enrollment Analyst

The Operations Command Center (OCC) is a centralized team responsible for ensuring the seamless execution of operational processes, enabling scalable workflows, and proactively preventing operational issues through process ownership, problem management, and continuous improvement. As an Operations Analyst, EDI Enrollment, you will play a critical role in supporting electronic transaction enrollment activities that enable successful payer, clearinghouse, and trading partner connectivity for HHAeXchange providers.

This role is responsible for coordinating and executing enrollment activities for supported electronic healthcare transactions, including claims submission (837), electronic remittance advice (835), eligibility (270/271), and other approved transaction types. The Operations Analyst serves as the operational owner of the enrollment process, initiating enrollments when permitted, tracking progress, coordinating follow-up activities, and ensuring enrollment requirements are clearly documented and communicated.

The ideal candidate is highly organized, detail-oriented, and skilled at transforming complex payer and clearinghouse requirements into clear, actionable guidance. This individual will work closely with Customer Success Managers, Project Managers, Revenue Cycle Operations, Customer Experience, and external trading partners to improve enrollment outcomes, reduce provider confusion, and create a more scalable enrollment experience for customers.

This is a hybrid position, with an expectation to report to the Miami, FL office 3 days/week (typically Tues/Wed/Thurs). 

To perform this job successfully, an individual must be able to perform each essential job duty satisfactorily with or without reasonable accommodation. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Job Duties

Manage electronic transaction enrollment activities for supported transaction types, including claims (837), remittance advice (835), eligibility (270/271), and future enrollment programs as applicable.
Initiate, coordinate, track, and facilitate enrollment requests through payer, clearinghouse, and trading partner enrollment systems and portals.
Serve as the operational owner of assigned enrollment activities, ensuring timely follow-up, issue resolution, status tracking, and completion of enrollment requirements within established timelines.
Maintain accurate enrollment records, case documentation, status updates, and related artifacts within Salesforce and other designated systems.
Establish and maintain effective working relationships with payers, clearinghouses, and other trading partners to support enrollment processing, status tracking, issue resolution, and escalation management.
Research, interpret, and maintain expertise in payer, clearinghouse, and trading partner enrollment requirements, policies, and processes.
Develop and maintain provider-facing enrollment guides, templates, instructional materials, and process documentation in partnership with the Customer Experience team to ensure content accuracy, consistency, branding, and alignment with organizational standards.
Translate complex enrollment requirements and third-party documentation into clear, actionable guidance for providers and internal stakeholders.
Collaborate with the Customer Experience team to review, publish, and maintain customer-facing knowledge base content and enrollment-related communications.
Partner with Customer Success Managers, Project Managers, Revenue Cycle Operations, and other stakeholders to ensure enrollment requirements, status updates, and provider responsibilities are communicated clearly and consistently.
Create and maintain standard operating procedures, workflow documentation, and internal knowledge assets that promote consistent execution and operational scalability.
Identify enrollment bottlenecks, recurring challenges, and process improvement opportunities, recommending solutions that improve enrollment efficiency and provider experience.
Support automation, reporting, and continuous improvement initiatives that enhance enrollment operations, reduce manual effort, and improve operational visibility.

Other Job Duties

• Other duties as assigned by supervisor or HHAeXchange leader.

Travel Requirements

• Travel up to 10%, including overnight travel

Required Education, Experience, Certifications and Skills

2-5 years of experience in healthcare operations, payer enrollment, revenue cycle support, provider onboarding, interoperability support, or related operational roles.
Working knowledge of healthcare electronic transactions, including 837 claims, 835 remittance advice, eligibility transactions, and payer enrollment processes.
Experience working with healthcare payers, clearinghouses, enrollment programs, or provider onboarding activities.
Experience managing work through CRM or case management platforms such as Salesforce.
Strong analytical and problem-solving skills with exceptional attention to detail.
Excellent organizational skills and ability to manage multiple enrollment activities simultaneously.
Exceptional written and verbal communication skills with the ability to simplify and communicate complex information clearly.
Experience creating process documentation, job aids, knowledge articles, standard operating procedures, or instructional materials.
Ability to build effective working relationships with internal stakeholders and external business partners.
Proficiency with Microsoft Office applications, particularly Excel, Word, and PowerPoint.
Ability to work both independently and collaboratively in a fast-paced environment.
Bachelor's degree in Business, Healthcare Administration, Information Systems, or a related field, or equivalent work experience, preferred.