(EDI) Specialist Williston, VT (Hybrid)

Gainwell Technologies LLC•Any city, OH

6d•$43,800 - $62,500•Hybrid

About The Position

The Electronic Data Interchange (EDI) Specialist serves as the primary point of contact for Vermont Medicaid providers, clearinghouses, and trading partners regarding electronic healthcare transactions. This position is responsible for supporting provider enrollment and maintenance of Electronic Data Interchange (EDI) services, troubleshooting electronic claims submission issues, managing trading partner relationships, and ensuring compliance with HIPAA transaction standards. The EDI Specialist partners with internal teams and external stakeholders to promote efficient electronic business processes and a positive provider experience.

Requirements

Associate’s degree in Business, Health Information Management, Information Technology, Healthcare Administration, or a related field; equivalent experience may be considered.
Minimum of 2 years of experience in customer service, provider services, claims processing, healthcare operations, or EDI support.
Experience working with healthcare providers, electronic transactions, claims, or related healthcare processes.
Proficiency with Microsoft Office applications and data management systems.
Ability to comply with HIPAA, Medicaid requirements, and contractual standards while maintaining accurate documentation.
Strong written and verbal communication skills with the ability to educate and assist providers professionally.
Strong analytical, problem-solving, and troubleshooting skills.
Excellent attention to detail when processing enrollments, transactions, and provider information.
Strong organization and time management skills with the ability to manage multiple priorities.
Technical aptitude with the ability to learn and support EDI transactions, provider portals, and healthcare information systems.

Nice To Haves

Experience supporting Medicaid, Medicare, or healthcare payer programs.
Working knowledge of HIPAA-compliant EDI transaction sets.
Experience with provider enrollment, claims processing, electronic billing, or clearinghouse operations.
Familiarity with provider portal technologies and healthcare information systems.
Experience delivering training or customer education programs.

Responsibilities

Serve as the primary point of contact for Vermont Medicaid providers, clearinghouses, and trading partners regarding electronic healthcare transactions.
Support provider enrollment and maintenance of Electronic Data Interchange (EDI) services.
Troubleshoot electronic claims submission issues.
Manage trading partner relationships.
Ensure compliance with HIPAA transaction standards.
Partner with internal teams and external stakeholders to promote efficient electronic business processes and a positive provider experience.