EDI 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.

Key Responsibilities:

• Manage end-to-end EDI transactions (837, 835, 270/271, 276/277, 278) for claims and remittances.
• Onboard and manage payers and clearinghouses; ensure EDI compliance and testing.
• Analyze and resolve transaction errors, rejections, and denials.
• Oversee EDI integration with billing and EHR/PM systems.
• EDI profiles understanding data elements, segments, and loops within an EDI file are structured and interpreted.
• Setting up new clients
• Insurance Master Import. EDI configuration setup (SFTP and BIZUDS).
• SFTP notifications (SFTP blocking). Monitoring EDI folders for pending files.
• Billing Sanity check for Upgraded/shifted RCM Clients. Claims (EDI837/837i) related issue.
• Eligibility Issues (EDI270 and EDI271). Acknowledgements EDI997 and EDI277 Issues.
• Remittances EDI835 issue and resolution.
• Resolution on Rejections and Denial issues.
• Coordination with Clearinghouses.
• Patient Statement Setup.
• Resolv RCM Client Termination Process.
• Coordinate with the engineering team regarding problems and enhancements.
• Miscellaneous Activities.

Qualifications:

• Bachelors degree in IT, Healthcare, or related field.
• 57 years of healthcare EDI experience with RCM exposure.
• Knowledge of HIPAA, X12 transaction sets, and payer workflows.
• Strong problem-solving, communication, and vendor management skills.

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

Preferred candidates from Maharashtra

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
• Lifestyle Rewards Program
• Group Term Life Insurance
• Gratuity
• ...and more!