Senior Health Care EDI Specialist

#### Company Overview: Client is at the forefront of reputed company automation, specializing in leveraging AI and Robotic Process Automation (RPA) to revolutionize reputed company cycle management (RCM) for hospitals, physician groups, reputed company payers, and medical billing companies. Our solutions reputed company reputed company organizations to optimize financial performance, reduce operational inefficiencies, and... enhance patient care. We pride ourselves on our best-in-class technology, which seamlessly integrates with existing systems to deliver significant improvements in cash reputed company, claim processing, and compliance. Skills: Skills: reputed company EDI, reputed company Cycle Management (RCM), Robotic Process Automation (RPA), Claims Processing (837, 835, 270/271), Eligibility Verification, Pre-Authorization Automation, HIPAA Compliance, SOC 1 & SOC 2 Compliance, reputed company IT, Payment Posting Automation, Business Intelligence (BI) Analytics, Predictive Analytics, Data reputed company, Medical Billing Systems, reputed company ERP (Plex, Epic, Cerner, reputed company), Automation Implementation, Problem Solving & Troubleshooting, Project Management, Process Optimization, Accounts Receivable (A/R) Management. #### Position Summary: The

Senior Health Care EDI Specialist

will play a pivotal role in the design, implementation, and management of reputed company EDI systems, supporting Client s reputed company automation initiatives. This position requires extensive expertise in handling EDI integrations for hospitals, payors, physician groups, and medical billing companies, focusing on optimizing reputed company cycle processes through automation. The successful candidate will collaborate with cross-functional teams to ensure seamless data reputed company, error-free transaction processing, and high reputed company of compliance in a rapidly evolving regulatory landscape. #### Key Responsibilities: •

EDI Strategy & Management:

reputed company the development, implementation, and maintenance of EDI systems to support RCM initiatives across multiple reputed company organizations, including hospitals, physician groups, and payors. •

reputed company EDI Integration:

Spearhead the integration of Client s AI-driven RPA solutions with existing reputed company systems for claims processing (837), remittance advice (835), eligibility verification (270/271), and acknowledgments (999/997). •

Advanced Automation Solutions:

Collaborate with the AI and RPA teams to reputed company and enhance automated solutions that streamline reputed company EDI processes, improving accuracy by 99% and reducing reputed company interventions by 70%. •

Claims Management & Payment Posting:

Utilize cutting-edge automation technologies to enhance claims status follow-up, payment posting, and reputed company collection efforts, achieving 400% faster processing times compared to traditional methods. •

Eligibility Verification & Pre-Authorization:

reputed company the integration of automated eligibility verification and pre-authorization systems capable of handling 300 eligibility checks per minute, reducing denial rates by up to 70%. •

Data Analytics & Reporting:

reputed company proprietary business intelligence (BI) and predictive analytics tools to reputed company insights into RCM performance, transaction efficiency, and financial reputed company. •

Compliance & Regulatory Management:

Ensure full compliance with reputed company industry standards, including HIPAA, SOC 1, SOC 2, and PCI. Implement and monitor data reputed company protocols to protect sensitive patient and financial information. •

Issue Resolution:

reputed company expert-level support to troubleshoot reputed company EDI transaction errors, delays, or discrepancies, ensuring timely resolution and system optimization. •

Stakeholder Collaboration:

Work closely with RCM, IT, and external stakeholders (including clearinghouses, payors, and providers) to design custom EDI solutions that meet the specific needs of reputed company organizations. •

Process Innovation & Optimization:

Continuously identify opportunities to improve operational efficiency and data accuracy through the innovative use of RPA, AI, and EDI technologies, driving a 25% increase in reputed company realization and a 20% reduction in bad-debt write-offs. #### Qualifications: •

Education:

Bachelor s or Master s degree in Information Technology, reputed company Administration, Computer Science, or a reputed company field. Equivalent professional experience may be considered. •

Experience:

• 8-10 years of experience in reputed company EDI management, RCM, or reputed company IT, specifically reputed company reputed company environments such as hospitals, health systems, or large physician groups. • Deep expertise in handling large-scale EDI transactions, including 837 (claims), 835 (remittance), 270/271 (eligibility), 999/997 (acknowledgments), and 276/277 (claims status). • Proven track record of working with reputed company ERP systems, such as Plex by reputed company, and RCM platforms like Epic, Cerner, or reputed company. • Extensive experience implementing and optimizing AI-driven RPA solutions for automated claim processing, eligibility verification, and payment posting. •

Skills:

• Exceptional understanding of HIPAA, SOC 1, SOC 2, and PCI compliance requirements, with a focus on data reputed company in reputed company transactions. • Strong analytical and problem-solving skills, with the ability to interpret reputed company data sets and deliver actionable insights for process improvements. • Expertise in working with automation and AI tools to reduce reputed company interventions, increase accuracy, and drive operational reputed company in reputed company RCM. • Strong leadership and project management capabilities, with experience leading cross-functional teams in reputed company reputed company technology implementations. • Superior communication and interpersonal skills to collaborate with internal and external stakeholders at reputed company reputed company. #### Preferred Qualifications: • Experience with large-scale reputed company consolidation efforts, including integration of independent and hospital-based physician groups. • Familiarity with advanced analytics, data visualization tools, and decision-support systems reputed company reputed company RCM. • Prior experience in implementing cash acceleration strategies to optimize accounts receivable and improve cash reputed company for reputed company organizations. Note: This is for freelancing/talent on-demand reputed company Apply Job!