The EDI (Electronic Data Interchange) Enrollment Specialist will be responsible for ensuring the successful submission of claims through the clearinghouse and be the primary liaison between Somnia and the clearinghouse vendor. Works closely with the provider enrollment team to ensure group and provider enrollments through EDI processes are timely and complete. Manages, provides analysis, and effectively communicates clearinghouse denials or rejections to the appropriate staff and leadership.

• Prepare and submit applications to configure Electronic Data Interchange (EDI) claims and Electronic Remittance Advice (ERA) through clearinghouse and other payer portals.
• Prepare and submit applications to configure Electronic Funds Transfer (EFT) with payers.
• Initiate investigations with clearinghouse vendor regarding denials and errors in a timely fashion.
• Review correspondence received from payers and action appropriately for resolution.
• Knowledgeable with Group Entity health plan enrollments, state regulations and appeal processes.
• Develop and monitor KPIs to ensure maximum claims throughput, minimize error rates and maximize clean claims rate.
• Resolve enrollment issues through office staff, management, and others as identified. Maintain positive working relationships with all staff.
• Proactively develop and maintain relationships with major payers.
• Continuously search for process improvements to achieve accuracy and efficiency.
• Perform other duties as assigned or required.

SKILLS/QUALIFICATIONS:

• Proficiency in Microsoft Word, Excel, Outlook, PDF Software, and other management tools.
• Motivated to quickly learn and demonstrate strong problem-solving skills.
• Strong project management and multitasking skills.
• Excellent interpersonal and communication skills.
• Strong writing skills and attention to detail.
• Strong organizational skills and ability to be attentive to details.

EDUCATION/EXPERIENCE:

• High School Diploma or equivalent.
• Minimum 5 years’ experience in claims submission and Electronic Data Exchange (EDI) processes as well as EDI Enrollment.
• Experience in Anesthesia Enrollment preferred but not required.