EDI & Healthplan Specialist

Job Title:
EDI & Healthplan Specialist

Location: Gilbert, AZ

Department: Revenue Cycle Management – Post-Acute Care

Position Type: Full-Time

Job Summary:

The EDI & Healthplan Specialist plays a key role in assisting clients with the enrollment process for insurance payers and facilitating the submission of electronic claims and remittances. This position involves processing enrollment requests, addressing inquiries, resolving complaints, and updating databases. The role requires a strong focus on customer service, attention to detail, and the ability to troubleshoot and escalate technical issues as needed.

Key Responsibilities:

• Process enrollment requests for both commercial and government insurance plans for new and existing clients, acting as the intermediary between clients and the clearinghouse.
• Respond to client inquiries regarding enrollment status and related concerns.
• Update and maintain insurance records in the system as necessary.
• Adhere to departmental guidelines for case tracking and system updates.
• Handle customer and internal escalations, ensuring compliance with departmental protocols.

Qualifications:

• High school diploma or equivalent.
• Two (2) years of experience in an insurance, finance, medical office, or customer service-related field.
• Proficiency in Microsoft Word and Excel.
• Proven ability to follow established procedures and workflows consistently.
• Strong attention to detail, with the ability to manage tasks accurately and completely.
• Ability to prioritize and handle multiple tasks simultaneously.
• Capacity to perform analytical tasks with minimal supervision.
• Ability to work both independently and as part of a team.
• Strong verbal and written communication skills, with the ability to engage effectively with customers and partners.
• Knowledge of electronic insurance setups and processes.
• Electronic Data Interchange (EDI) experience
• Experience with multiple EDI enrollment platforms (Waystar, EDISS, Change Healthcare, etc.).

Preferred Qualifications:

• Associate's degree in accounting, finance, health information technology, or another related field.
• Revenue Cycle (healthcare business, financial, or insurance) experience.
• Knowledge of medical and insurance terminology, CPT, ICD coding structures, and billing forms.

Physical Requirements

• Able to lift 25 pounds for routine performance of essential functions.
• May be exposed to adverse indoor and outdoor environmental conditions.
• Be able to perform prolonged sitting, standing, and walking.

Job Type: Full-time

Pay: $21-28/hour

Benefits:

• 401(k)
• Dental Insurance
• Health insurance
• Paid time off
• Vision insurance

Shift:

• Day shift

Ability to Commute:

• Gilbert, AZ 85297 (Required)

Ability to Relocate:

• Gilbert, AZ 85297: Relocate before starting work (Preferred)

Work Location: In person

Job Type: Full-time

Pay: $21.00 - $28.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• Day shift
• Monday to Friday

Application Question(s):

• Have you connected billing platforms to payors so they can exchange information?

Experience:

• EDI: 2 years (Required)

Location:

• Gilbert, AZ 85297 (Preferred)

Ability to Commute:

• Gilbert, AZ 85297 (Required)

Work Location: In person

Salary : $21 - $28