PDS Health · 22 hours ago
Specialist, EDI Enrollment
Irving, TX
Full-time
Onsite
Entry, Mid Level
$20.50/hr - $26.70/hr
2+ years expPDS Health is seeking a Specialist, EDI Enrollment to process electronic enrollments for dental providers and insurance payers. The role involves ensuring proper setup in the Electronic Data Interchange (EDI) system for claims submission and payment processing, as well as maintaining provider data and supporting enrollment queries.
DentalFitnessHealth CareWellness
Responsibilities
Process electronic enrollment applications for dental providers with insurance companies
Ensure accurate and timely submission of enrollment forms, claims, and other necessary documentation to insurance carriers
Verify and maintain accurate provider information in the EDI system to ensure smooth claims and payment processing
Troubleshoot and resolve EDI transaction issues, including eligibility verification and claim rejections
Provide support to dental offices with EDI enrollment and claims processing questions or issues
Monitor EDI transactions to ensure compliance with industry standards and insurance company requirements
Assist onboarding new dental offices, ensuring they are properly set up in the EDI system
Work closely with insurance payers to resolve claims and provider enrollment discrepancies or issues
Generate and review reports to track enrollment status and claims processing, identifying areas for improvement or potential issues
Coordinate with internal teams to ensure smooth workflow between the EDI system, claims processing, and provider support teams
Ensure all documentation is compliant with HIPAA and other relevant regulations to maintain confidentiality and security of patient data
Other duties and responsibilities as assigned
Qualification
Required
Equivalent to high school diploma or general education (GED)
2+ years of experience in revenue cycle management
Experience in testing and troubleshooting EDI systems and applications
Ability to stay informed and maintain up-to-date knowledge of changes in EDI regulations and insurance company's policies and requirements
Familiarity with healthcare claims processing, electronic remittance advice (ERA), and electronic funds transfer (EFT)
Knowledge of and ability to ensure compliance with HIPAA and other guidelines and regulations
Proficiency using clearinghouse portals for EDI transactions
Ability to investigate and resolve enrollment issues with payers
Demonstrated effective interpersonal, verbal and written communication skills to interact with various departments and external stakeholders
Ability to effectively multitask to manage multiple enrollment tasks simultaneously
Detailed-oriented with a high level of accuracy in maintaining enrollment records and processing applications
Ability to manage projects and programs related to EDI enrollment
Ability to effectively collaborate, work independently, and as part of a team with internal and external partners
Preferred
Associate's degree in related field of study from an accredited college or university
Experience in revenue cycle management within healthcare, dental, medical or retail
Experience with EDI enrollment
Benefits
Medical, dental, and vision insurance
Paid time off
Tuition Reimbursement
401K
Paid time to volunteer in your local community
Company
PDS Health
Founded in 1994, PDS Health is a leading healthcare support organization that partners with dental and medical providers across the U.S., providing comprehensive business services that enable clinicians to focus on high-quality patient care.
10001+ employees
Funding
Current Stage
Late StageTotal Funding
unknownKey Investors
SMILE Health
2023-08-08Non Equity Assistance
Leadership Team
Stephen Thorne
Founder & CEO
Jeremy Jonckheere
Vice President, Strategic Payor Partnerships
Recent News
New Orleans CityBusiness
2025-09-03
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