Call Center Agent - Provider Lead EDI - Hybrid - West Sacramento, CA
About The Position
Provider Level 2 EDI Agents are responsible for responding to basic to moderately complex provider and submitter telephone calls involving program recognized electronic data interchange transactions and troubleshooting. Your role in our mission is to provide technical support to healthcare providers, billing offices, and trading partners regarding Provider Portal and EDI functionality. You will investigate Electronic Data Interchange (EDI) transaction issues involving claim submissions, claim acknowledgments, eligibility requests (270/271), claim status requests (276/277), remittance transactions (835), and enrollment requests. You will also support providers and trading partners with EDI enrollment, testing, setup, and connectivity requirements. This includes analyzing EDI rejections, edits, and error reports to determine root causes and provide resolution guidance. You will research provider and submitter calls/inquiries and respond to appropriate parties in accordance with service level agreements (SLAs). Finally, you will document all interactions, troubleshooting steps, resolutions, and escalations in the customer relationship management (CRM) ticketing solution.
Requirements
- Knowledge of healthcare claims processing and provider operations.
- Understanding of HIPAA-compliant EDI transactions (837, 835, 270/271, 276/277, 278).
- Experience supporting web-based applications, provider portals, or healthcare technology platforms.
- Ability to interpret EDI files, rejection reports, and transaction acknowledgments.
- Strong analytical, troubleshooting, and problem-solving skills.
- Excellent verbal and written communication skills.
- Experience using ticketing and customer relationship management (CRM) systems.
- Strong customer service orientation with a focus on provider satisfaction and issue resolution.
- Business and analytical problem-solving skills.
- Communication skills written and oral.
- Ability to work independently and follow oral and written instructions.
- Ability to navigate Microsoft Word, Microsoft Teams, Microsoft Outlook, and internet browsers.
Nice To Haves
- Knowledge of HIPAA-compliant EDI transactions (837, 835, 270/271, 276/277, 278) strongly preferred.
Responsibilities
- Provide technical support to healthcare providers, billing offices, and trading partners regarding Provider Portal and EDI functionality.
- Investigate Electronic Data Interchange (EDI) transaction issues involving claim submissions, claim acknowledgments, eligibility requests (270/271), claim status requests (276/277), remittance transactions (835), and enrollment requests.
- Support providers and trading partners with EDI enrollment, testing, setup, and connectivity requirements.
- Analyze EDI rejections, edits, and error reports to determine root causes and provide resolution guidance.
- Research provider and submitter calls/inquiries and responds to appropriate parties in accordance with service level agreements (SLAs).
- Document all interactions, troubleshooting steps, resolutions, and escalations in the customer relationship management (CRM) ticketing solution.
Benefits
- Flexible vacation policy
- 401(k) employer match
- Comprehensive health benefits
- Educational assistance
- Leadership and technical development academies
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
