EDI Claims Specialist in Sandy, Utah at Aleracare

About Pure Infusion

Pure Infusion is a leading healthcare infusion services company providing high-quality, patient-centered infusion therapy across multiple clinic locations. We have been recognized as the fastest-growing company in Utah for two years in a row as of October 2025. Born from the merger of Pure Infusion Suites and Aleracare, we are building a unified organization grounded in a strong culture of excellence, accountability, and genuine care for patients and employees alike. Headquartered in Salt Lake City, Utah, with operations spanning multiple states, we are in a pivotal stage of growth and integration and we’re looking for people who want to help shape what comes next.

If you’ve been looking for a healthcare position that truly allows you to love on, personally care for, and intentionally work with patients without the chaos of traditional healthcare systems, then Pure is likely what you have been waiting for, we hope you’ll keep reading.

OUR CORE VALUES

We live by four core values that define our culture and guide our hiring:

• People-obsessed
• Relentlessly Improving
• Innovators
• Grateful

In addition to a competitive rates, we offer the following benefits:

• 401(k) Matching
• Health, Vision, and Dental Insurance
• Over 20 days of paid time off annually

Position Summary:

The EDI claim specialist is responsible for managing and maintaining all electronic data interchange (EDI) activities between AdvancedMD, Waystar, and associated payers. This role ensures clean, timely, and compliant transmission of claims, remits, and eligibility files. The ideal candidate will serve as a central point of contact for EDI enrollments, troubleshooting, and transmission issues while supporting billing operations across multiple states and payers.

Key Responsibilities:

• Manage and monitor EDI transmissions via AdvancedMD and Waystar, including 837, 835, 999, 277CA, and eligibility (270/271) files.
• Oversee and track EDI enrollment setup and status for new and existing payers across all states.
• Investigate and resolve EDI rejections, failed batches, and clearinghouse errors.
• Differentiate claim-content rejections — driven by claim/scrubber edits, coding errors, or payer policy and medical-policy changes — from transmission and enrollment failures, and route root cause back to billing, coding, and credentialing for correction.
• Liaise with payer EDI departments and Waystar support to ensure file compliance and resolution of delays.
• Work with internal billing, credentialing, and IT teams to ensure accurate mapping and payer ID usage in AMD.
• Maintain accurate documentation of payer-specific rules, enrollment timelines, and transmission processes.
• Validate that all ERA (835) files are posting correctly and reconcile any gaps in remittance data.
• Regularly review and report on EDI performance metrics, rejection rates, and trends.
• Assist in testing new file formats, NPI/tax ID enrollments, and payer migrations within AMD and Waystar.

Required Qualifications:

• 2+ years of experience with EDI in a healthcare billing or RCM environment.
• Strong medical billing background working command of CPT/HCPCS and J-codes, ICD-10, modifiers, units/NDC, and NCCI/MUE edits sufficient to read a 277CA or scrubber edit and identify the underlying coding or payer-policy cause of a rejection.
• Proven ability to manage payer-specific EDI setup and escalations.
• Ensure compliance with HIPAA EDI standards and internal RCM protocols.
• Excellent written and verbal communication, especially when working with payer tech support.

Preferred Qualifications:

• Experience with multi-state payer setups and crosswalk management inPMS.
• Hands-on experience with AdvancedMD and Waystar clearinghouse systems.
• Working knowledge of claims workflows in infusion services or specialty clinics.
• Familiarity with ERA auto-posting logic and reconciliation.
• Experience coordinating with offshore teams or large RCM departments.

Work Environment:

• Remote or hybrid work options available.
• Occasional scheduled meetings with billing team, payers, and vendors.
• Cross-functional collaboration with RCM, credentialing, and tech support.