Job Description:
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), where applicable
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 enrollment 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 Cre

📌 Payer Enrollment Specialist (Vadodara)
🏢 Qualifacts
📍 Vadodara