Payer Enrollment Specialist - RCMS

Job Title: Payer/EDI Enrollment Specialist

·        The EDI Enrollment Specialist works closely with Billing, Accounts Receivable (AR), Payment Posting, Credentialing, Client Success, Implementations, Clearinghouses, and U.S.-based teams to establish and maintain electronic connectivity, resolve enrollment-related issues, and minimize reimbursement delays.

·        The role requires strong attention to detail, proactive payer follow-up, effective issue resolution, and accurate documentation to support operational efficiency and compliance.

·        Key Responsibilities:

·        EDI Enrollment Management

·        Prepare, submit, monitor, and maintain EDI enrollment requests for electronic transactions, including Electronic Claims (837), Electronic Remittance Advice (ERA/835), Electronic Funds Transfer (EFT), Claim Status transactions (276/277), and Eligibility transactions (270/271), where applicable.

·        Complete payer-specific electronic enrollment applications through payer portals, clearinghouses, and paper enrollment processes, as required.

·        Coordinate EDI enrollments with clearinghouses and insurance payers to establish electronic connectivity for assigned providers and client groups.

·        Validate provider demographic information, National Provider Identifier (NPI), Tax Identification Number (TIN), billing information, and banking details before submission to ensure accuracy.

·        Track enrollment status, payer responses, effective dates, approvals, and activation milestones through completion.

·        Payer & Clearinghouse Follow-Up

·        Perform timely follow-up with insurance payers and clearinghouses to obtain enrollment status, resolve deficiencies, and expedite approvals.

·        Investigate and resolve rejected, delayed, or incomplete EDI enrollment requests.

·        Escalate aging enrollments, payer delays, or connectivity issues that may impact claims submission or payment processing.

·        Maintain consistent communication with internal stakeholders regarding enrollment progress, risks, and expected completion timelines.

·        Documentation & Quality

·        Maintain accurate documentation within enrollment systems, work queues, trackers, CMD records, and document repositories.

·        Document payer communications, enrollment approvals, rejection reasons, and corrective actions in accordance with RCMS documentation standards.

·        Ensure all enrollment records are complete, current, and audit-ready.

·        Safeguard sensitive provider and banking information while adhering to HIPAA and organizational security requirements.

·        Cross-Functional Collaboration

·        Partner with Credentialing, Billing, AR, Payment Posting, Client Success, Implementations, and U.S.-based teams to support provider onboarding and revenue cycle readiness.

·        Coordinate with internal departments to resolve enrollment dependencies affecting electronic claims submission or payment processing.

·        Support new client implementations, provider onboarding, and organizational growth initiatives by ensuring timely EDI setup.

·        Identify process improvement opportunities to reduce enrollment turnaround times, improve first-pass approval rates, and standardize EDI workflows.

·        Assist in training team members and sharing payer-specific EDI enrollment knowledge and best practices.

This is an onsite position, 5 days/week, in the Vadodara office working the NIGHT SHIFT. Hours are 6:30pm-3:30am IST. Remote applicants will not be considered.