The Role
Provide technical analysis and support for EDI transactions (enrollment, claims, payments). Lead EDI implementation improvements, design/review integrations, troubleshoot with Development/QA, coordinate with vendors/clearinghouses/payers, respond to provider inquiries, train clients, maintain records, and identify process improvements.
Summary Generated by Built In
Job Description:
The Specialist I, EDI provides technical analysis and support to both internal and external customers on EDI-related issues (i.e., electronic exchange of data including enrollment, claims, payments, and clearinghouse activities)- Lead, coordinate and administer key process improvement to EDI implementations.
- Participates in design and review of new applications and integration strategies of EDI systems.
- Work closely with Development and QA to troubleshoot and resolve issues.
- Responds to inquiries relating to EDI from providers and internal departments.
- Collaborate with third party vendors, clearinghouse, and payers to resolve operational and transactional issues. Communicate with vendors frequently to provide client solutions.
- Train clients and assist presales team as needed with demo product features to potential clients.
- Maintain all records and files with accuracy; track and follow up on documents and notify clients of upcoming due dates.
- Research and resolving client issues.
- Identify opportunities to improve processes and contribute to the improvement process.
- Perform other duties that support the overall objective of the position.
Education Required:
- Bachelor's degree.
- Or, any combination of education and experience which would provide the required qualifications for the position.
Experience Required:
- 1+ year working with software implementation or project management.
- 1+ year use NextGen PM or similar practice management software solution.
- 2+ years of Customer Service experience.
- Experience with Claim Processing.
- Experience with product training.
Knowledge, Skills & Abilities:
- Knowledge of: Fundamental knowledge of networking protocols. ISP's and internet security, and EDI standards. Knowledge and understanding of various products and multiple levels of benefits within each product. Proficient with PC's and in Windows based environments
- Skill in: Technical expertise, problem solving, research, analytical, communication, organized with attention to detail.
- Ability to: Manage multiple tasks and prioritize in a fast-paced environment, utilize tools and resources to ensure that functions are efficient, accurate, and timely, navigate a computer while on the phone, read and understand X12 raw data files, use multiple online portals to complete responsibilities.
The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is intended to provide guidelines for job expectations and the employee's ability to perform the position described. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate. This document does not represent a contract of employment, and the company reserves the right to change this job description and/or assign tasks for the employee to perform, as the company may deem appropriate.
NextGen Healthcare is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
Skills Required
- Bachelor's degree or equivalent combination of education and experience
- 1+ year working with software implementation or project management
- 1+ year use of NextGen PM or similar practice management software
- 2+ years of customer service experience
- Experience with claim processing
- Experience with product training
- Knowledge of EDI standards and ability to read/understand X12 raw data files
- Fundamental knowledge of networking protocols, ISPs, and internet security
- Proficient with PCs and Windows-based environments
- Technical troubleshooting, problem solving, research and analytical skills
- Ability to manage multiple tasks, prioritize, and navigate a computer while on the phone
NextGen Healthcare Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about NextGen Healthcare and has not been reviewed or approved by NextGen Healthcare.
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Healthcare Strength — Health coverage includes multiple Anthem medical options plus dental and vision, and company HSA contributions are provided for HDHP selections. Wellbeing resources such as mental health support and fitness programs complement the core plans.
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Wellbeing & Lifestyle Benefits — A Lifestyle Spending Account, paid Volunteer Time Off, and Employee Resource Groups are highlighted alongside flexible and remote‑friendly work arrangements. These extras add lifestyle and community value beyond core insurance.
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Fair & Transparent Compensation — Sales compensation plans are characterized as fair and transparent with competitive on‑target earnings in go‑to‑market roles. Top performers can achieve higher outcomes under these structures.
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The Company
What We Do
NextGen Healthcare is on a relentless quest to improve the lives of those who practice medicine and those they care for. We provide tailored solutions to fit the precise needs of ambulatory practices, as they strive to reach the quadruple aim while navigating the journey of value-based care. The result? Healthier patients and happier providers.
