Electronic Data Interchange (EDI) Specialist

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.

• 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., * 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.

What you should expect in this role

• 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.

The pay range for this position is $43,800.00 - $62,500.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits , and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development.