Managed Care Data Exchange Specialist

National Vision•Lawrenceville, GA

About The Position

The Managed Care Data Exchange Specialist plays a critical role in ensuring the seamless processing of billing transactions between National Vision and managed care organizations. This position requires expertise in managed vision care, electronic data interchange (EDI) and application programming interface (API) technologies to support efficient, accurate, and compliant billing operations. What Would You Do? The Specifics. Coordinate and manage the end-to-end billing infrastructure for managed vision care plans, focusing on point-of-sale calculation, claim submission, payment posting, and reconciliation accuracy. Set up and maintain managed vision care plan calculations of customer responsibility and insurance payments in the point of sale system. Utilize EDI platforms to transmit and receive healthcare claims, remittance advices, and eligibility verifications; troubleshoot and resolve EDI transaction errors. Integrate and maintain API connections with payers and internal systems to automate data exchange and enhance process efficiency. Collaborate with IT, revenue cycle, and payer relations teams to ensure compliance with managed care contract requirements and industry regulations. Analyze billing data, identify trends or discrepancies to identify root causes of problems, and recommend process improvements to maximize reimbursement and reduce rejections, denials, and write-offs. Provide technical support and training to staff on EDI and API workflows. Maintain accurate documentation of billing processes, system configurations, and payer communications.

Requirements

2-4 years of experience in managed care billing, vision insurance, or healthcare logistics. (Required)
Two years of college or equivalent experience. in healthcare administration, business, information technology, or related field (Required)
General understanding of optical retail and managed vision care benefits. (Required)
Experience in using EDI formats (e.g., 837, 835, 270/271) and understanding of HIPAA transaction standards. (Required)
Experience with API protocols and integration with healthcare information systems. (Required)
Excellent analytical, problem-solving, and organizational skills and attention to detail. (Required)
Proven skill in analytical and critical thinking to understand complex data sources, evaluate both qualitative and quantitative information, and identify patterns and trends. (Required)
Strong communication and interpersonal abilities. (Required)
Collaborative approach to process changes to ensure integrity of all departmental processes. (Required)
Consumer-centric mindset to deliver excellent customer experiences. (Required)
Ability to work independently and collaboratively in a fast-paced environment. (Required)
Advanced Excel or data analysis skills. (Required)

Responsibilities

Coordinate and manage the end-to-end billing infrastructure for managed vision care plans, focusing on point-of-sale calculation, claim submission, payment posting, and reconciliation accuracy.
Set up and maintain managed vision care plan calculations of customer responsibility and insurance payments in the point of sale system.
Utilize EDI platforms to transmit and receive healthcare claims, remittance advices, and eligibility verifications; troubleshoot and resolve EDI transaction errors.
Integrate and maintain API connections with payers and internal systems to automate data exchange and enhance process efficiency.
Collaborate with IT, revenue cycle, and payer relations teams to ensure compliance with managed care contract requirements and industry regulations.
Analyze billing data, identify trends or discrepancies to identify root causes of problems, and recommend process improvements to maximize reimbursement and reduce rejections, denials, and write-offs.
Provide technical support and training to staff on EDI and API workflows.
Maintain accurate documentation of billing processes, system configurations, and payer communications.