American Vision Partners
Phoenix, Arizona
Job Description Job Description Overview This role is seeking candidates who specialize in EDI analytics and ERA/EFT Enrollments, we are not seeking developers and/or designers, thank you! As an EDI Analyst, you will be responsible for the development, implementation and ongoing maintenance of the Electronic Data Interchange (EDI) transactions including HIPAA 270/271 eligibility inquiry and response, 276/277 claims status inquiry and response, and 278 referral/prior authorization transactions. The EDI Specialist works with claims and payment teams on the HIPAA 837 -Health Care Claim and 835-Health Care Claim Payment/Advice. The EDI Specialist will work collaboratively with information systems staff, government and third-party payers, clearinghouses, and Nextgen technical support personnel to implement these transactions in an integrated, efficient, and cost-effective manner. This position will have responsibility for planning, implementing and managing HIPPA EDI projects relating to these transactions, including end-user contact, analysis, design, mapping, programming, training and documentation. Ideal candidates will require a certain level of revenue cycle management experience in order to successfully fulfill the job responsibilities. This position has the potential to be remote in the following states: Arizona, Nevada, California, New Mexico and Texas. Responsibilities Setup and Complete EDI registration for all EDI products, including facilitating payer-specific enrollments, until payer grant approval. Install and Configure healthcare electronic data interchange applications on provider's network and/or billing stations. Research and analyze providers' billing requirements to ensure all data fields are mapped and converted correctly in X12 ANSI inbound/outbound file. Initiates test EDI transaction prior initial implementation live environment. Conduct post-live support for 6 to 8 weeks by monitoring and assessing the overall usage of EDI products, and conducting weekly follow-up calls with billing administrators to ensure accuracy Customize the provider inbound/outbound EDI transactions based on specific payer edits/requirements received in responses. Make recommendation on additional resources and feature that adds leverage to EDI product and provides efficient solutions to the practice business operations. Devise solutions and provide status to revenue cycle leadership throughout the EDI implementation process on a bi-weekly basis. Serve as liaison between provider and healthcare trading partners regarding EDI inquiries including rejections with enrollment, claims, payments, and/or clearinghouse interfacing. Setup new payer/ connection setup, testing, and launch. Research and analyze new payer requests and submit to EDI QA/Development team to program accordingly. Maintains and update remit address changes with government and commercial payers weekly, monthly or quarterly Manage payer website logins, grant new access, deactivate access and provide password resets for revenue cycle management teams. Formal testing methodology, test plan development and execution, and documentation of test results All other assigned duties. Qualifications REQUIRED: Minimum five (5) years experience in Healthcare revenue cycle management (Payment Posting, Patient Access). A minimum of 2-3 years experience with hands-on involvement relative to ANSI X12 Healthcare EDI transaction sets (837, 999, 277CA, 276/277, 835) Experience with ERA/EFT enrollments from a hands-on analyst or role perspective. Prior EDI or System implementation and Transaction Mapping experience Experience in NextGen EHR system, or other healthcare EHR software. Proficient in Microsoft Office, specific but not limited to Excel (advanced formulas, pivot table use), PowerPoint, Word, Outlook, and SmartSheet navigation. High school diploma or GED required. BA/BS in Information Technology, Computer Science, Computer Engineering, equivalent is preferred. Previous experience in clearinghouse platform use and navigation, e.g. Waystar, Change Healthcare.
Job Description Job Description Overview This role is seeking candidates who specialize in EDI analytics and ERA/EFT Enrollments, we are not seeking developers and/or designers, thank you! As an EDI Analyst, you will be responsible for the development, implementation and ongoing maintenance of the Electronic Data Interchange (EDI) transactions including HIPAA 270/271 eligibility inquiry and response, 276/277 claims status inquiry and response, and 278 referral/prior authorization transactions. The EDI Specialist works with claims and payment teams on the HIPAA 837 -Health Care Claim and 835-Health Care Claim Payment/Advice. The EDI Specialist will work collaboratively with information systems staff, government and third-party payers, clearinghouses, and Nextgen technical support personnel to implement these transactions in an integrated, efficient, and cost-effective manner. This position will have responsibility for planning, implementing and managing HIPPA EDI projects relating to these transactions, including end-user contact, analysis, design, mapping, programming, training and documentation. Ideal candidates will require a certain level of revenue cycle management experience in order to successfully fulfill the job responsibilities. This position has the potential to be remote in the following states: Arizona, Nevada, California, New Mexico and Texas. Responsibilities Setup and Complete EDI registration for all EDI products, including facilitating payer-specific enrollments, until payer grant approval. Install and Configure healthcare electronic data interchange applications on provider's network and/or billing stations. Research and analyze providers' billing requirements to ensure all data fields are mapped and converted correctly in X12 ANSI inbound/outbound file. Initiates test EDI transaction prior initial implementation live environment. Conduct post-live support for 6 to 8 weeks by monitoring and assessing the overall usage of EDI products, and conducting weekly follow-up calls with billing administrators to ensure accuracy Customize the provider inbound/outbound EDI transactions based on specific payer edits/requirements received in responses. Make recommendation on additional resources and feature that adds leverage to EDI product and provides efficient solutions to the practice business operations. Devise solutions and provide status to revenue cycle leadership throughout the EDI implementation process on a bi-weekly basis. Serve as liaison between provider and healthcare trading partners regarding EDI inquiries including rejections with enrollment, claims, payments, and/or clearinghouse interfacing. Setup new payer/ connection setup, testing, and launch. Research and analyze new payer requests and submit to EDI QA/Development team to program accordingly. Maintains and update remit address changes with government and commercial payers weekly, monthly or quarterly Manage payer website logins, grant new access, deactivate access and provide password resets for revenue cycle management teams. Formal testing methodology, test plan development and execution, and documentation of test results All other assigned duties. Qualifications REQUIRED: Minimum five (5) years experience in Healthcare revenue cycle management (Payment Posting, Patient Access). A minimum of 2-3 years experience with hands-on involvement relative to ANSI X12 Healthcare EDI transaction sets (837, 999, 277CA, 276/277, 835) Experience with ERA/EFT enrollments from a hands-on analyst or role perspective. Prior EDI or System implementation and Transaction Mapping experience Experience in NextGen EHR system, or other healthcare EHR software. Proficient in Microsoft Office, specific but not limited to Excel (advanced formulas, pivot table use), PowerPoint, Word, Outlook, and SmartSheet navigation. High school diploma or GED required. BA/BS in Information Technology, Computer Science, Computer Engineering, equivalent is preferred. Previous experience in clearinghouse platform use and navigation, e.g. Waystar, Change Healthcare.
HHAeXchange
Job Description Job Description 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. The base salary range for this US-based, full-time, and exempt position is $58,000 - $65,000, not including variable compensation. An employee's exact starting salary will be based on various factors including but not limited to experience, education, training, merit, location, and the ability to exemplify the HHAeXchange core values. This is a benefits-eligible position. HHAeXchange offers competitive health plans, paid time-off, company paid holidays, 401K retirement program with a Company elected match, including other company sponsored programs. HHAeXchange is an equal-opportunity employer. The Company offers employment opportunities to all applicants and employees without regard to race, color, religion, national origin, sex, sexual orientation, gender identity or expression, age, disability, medical condition, marital status, veteran status, citizenship, genetic information, hairstyles, or any other status protected by local or federal law. We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.
Job Description Job Description 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. The base salary range for this US-based, full-time, and exempt position is $58,000 - $65,000, not including variable compensation. An employee's exact starting salary will be based on various factors including but not limited to experience, education, training, merit, location, and the ability to exemplify the HHAeXchange core values. This is a benefits-eligible position. HHAeXchange offers competitive health plans, paid time-off, company paid holidays, 401K retirement program with a Company elected match, including other company sponsored programs. HHAeXchange is an equal-opportunity employer. The Company offers employment opportunities to all applicants and employees without regard to race, color, religion, national origin, sex, sexual orientation, gender identity or expression, age, disability, medical condition, marital status, veteran status, citizenship, genetic information, hairstyles, or any other status protected by local or federal law. We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.