CBO EDI Associate

Position Summary / Scope of Responsibility:

MedVanta is the nation's largest physician-owned and operated next generation management services organization (MSO). Our services are specifically designed for musculoskeletal (MSK) providers and go beyond that of a traditional MSO, empowering our clients with the precise infrastructure, data, technology, and administrative processes needed to thrive both today and tomorrow.

MedVanta has an employee centered culture that supports and promotes diversity and inclusion. Our encouraging and empowering management style makes MedVanta a great place to further grow your knowledge while building a team driven path to success.

The EDI (Electronic Data Interchange) Associate is responsible for supporting electronic claims processing, troubleshooting transaction errors, and ensuring smooth electronic data interchange (EDI) operations. This role works closely with the billing, and payer teams to facilitate accurate and timely claim submissions and payment transactions.

Primary Responsibilities:

The incumbent may be asked to perform job-related tasks other than those specifically stated in this description. The duties and responsibilities of the position are to be carried out in a manner that is consistent with the Mission, Core Values and Operating Principles of MedVanta.

• Process and submit electronic healthcare claims through the EDI system in compliance with payer requirements including billing reconciliation.
• Manage all coverage claims submission. (Primary, secondary, tertiary.)
• Monitor and troubleshoot rejected or failed claims in the front end, identifying issues and taking corrective action.
• Assist in verifying payer enrollment and ensuring correct EDI setup for claim/remit transmission and updating EDI transactions (837, 835, 270/271, 276/277).
• Work with clearinghouses, insurance companies, and internal teams to resolve EDI-related issues.
• Ensure compliance with HIPAA regulations and healthcare EDI standards.
• Maintain accurate records of claims submissions, rejections, and resolutions.
• Performs and documents follow-through efforts in a timely manner.
• Coordinates medical record documentation to be submitted with claims.
• 7-day timeline requirement for confirming carriers have received and confirmed critical claims submitted that have been identified as high visibility/priority claims.
• Respond to internal inquiries related to electronic claim transmissions and payment files.
• Collaborate with the revenue cycle team to optimize workflows and improve claim acceptance rates.
• Performs all other duties as assigned.

Required Education and Experience:

·      High school diploma or GED equivalent required.

·      Bachelor’s degree in Business Administration, Healthcare Administration, or Electronic Data Management preferred.

·      Electronic Data Interchange certification strongly preferred.

·      Familiarity with EDI software and data management tools, or the ability to quickly learn and adapt to EDI platforms and processes.

·      Proficiency with Microsoft Office suite of products, as well as proficiency with standard office software and applications.

 ·     Outstanding time management skills and the ability to work effectively across multiple forms of communication and teams. 

Competencies and Required Skills

·       Strong interpersonal skills - ability to develop relationships and collaborate and influence in a centralized organization.

·       Demonstrated ability to organize, prioritize, and manage multiple tasks in a dynamic environment with a proven track record of results.

·       Strong interpersonal, oral, and written communication skills with excellent self-discipline and patience.

·       Able to work independently.

·       Exudes professionalism in presentation.

·       Must be able to read, write, speak, understand, and communicate in the English language.

Physical Demands:

·       Must be able to sit for long periods of time and lift up to 25 pounds

·       Must be able to use appropriate body mechanics techniques when performing desk duties.

·       Requires frequent bending, reaching, repetitive hand movements, standing, walking, squatting, and sitting.

·       Adequate hearing to perform duties in person and over telephone.

·       Must be able to communicate clearly to individuals in person and over the telephone.

·       Visual acuity adequate to perform job duties, including reading materials from printed sources and computer screens.