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Summary 
The Lead Electronic Data Interchange Specialist is responsible for overseeing daily system access requests and technology support tickets, ensuring timely resolution and adherence to service level agreements (SLAs). The role is responsible for monitoring ticket queues in the Electronic Medical Records system (EMR), maintaining accurate system documentation, and collaborating with internal teams and external vendors to troubleshoot issues. The position also supports revenue cycle operations by assisting with work queue assignments, identifying billing edit root causes, and implementing solutions to reduce claim denials. Additionally, the role includes assisting with reporting, facilitating team training, and serving as a liaison between departments and external partners to enhance system efficiency and billing accuracy. 

Qualifications 
Education Required:  
• Associate’s degree in Business, Healthcare Administration or related field 
• Equivalent experience will be considered in lieu of degree. 

Licenses/Certifications Required:  
• None 

Work Experience Required:  
• 2+ years of experience in healthcare revenue cycle 
• 2+ years of Epic experience 

Preferred Qualifications, Education, Licenses, Certifications, Experience, etc.: 
• 1+ year of experience in a lead or supervisory role preferred 
• Experience with Zotec and/or clearinghouse platforms preferred 

Knowledge, Skills, and Abilities 
• Strong knowledge in professional billing claims, coding, and/or insurance follow-up 
• Strong organizational and time management skills. 
• Excellent communication and problem-solving abilities. 
• Proficiency in Microsoft Office (Word, Excel, PowerPoint). 
• Ability to analyze and resolve access and system issues. 
• Familiarity with Zendesk and Service Now ticketing systems and workflow tools.

• Detail-oriented with a commitment to accuracy and compliance. 
• This role involves interaction and collaboration with other departments and requires excellent judgment and interpersonal skills.

Essential Duties and Responsibilities 
• Manage and prioritize daily Epic system access requests and Zendesk tickets to ensure timely resolution. 
• Monitor ticket queues and escalate issues as needed to meet SLA requirements. 
• Maintain accurate records of user access and system configurations. 
• Collaborate with users, IT, and vendor partners to troubleshoot and resolve system issues. 
• Assist with developing reports on ticket trends, resolution, ticket age, and turnaround times for leadership review. 
• Review and analyze billing edits and clearinghouse rejections to identify root causes, document findings, and collaborate with manager for solution. 
• Assist leader in providing work queue assignments, training and support to team members on billing processes and error resolution. 
• Provide direct oversight and support to both in-office and remote team members, serving as a primary resource for addressing questions, concerns, and clarification related to billing processes, workflows, and operational procedures. 
• Conduct weekly check-ins with team members (EDI Specialists) to assess workload distribution, address challenges, and reinforce performance expectations. 
• Compile and present weekly summaries of team member performance, system issues, and resolution status to leadership and provide feedback and recommendations for strategic improvements. 
• This role involves interaction and collaboration with other departments and requires excellent judgment and interpersonal skills.

GoHealth Core Values 
GoHealth’s Core Values, listed below, are essential functions of this position: 

• Collaboration: Takes ownership for collectively establishing productive partnerships and relationships and seek to gain joint understanding of priorities and objectives so that the greater good of the organization and those we serve is always at the forefront. 

• Innovation: Consistently uses good judgment, applying creativity to overcome obstacles and increasing effectiveness and efficiency through process and other forms of innovation. 
• Diversity & Inclusion:  Fosters diversity and inclusion, to be able to better understand team members, our customers and partners.  Engages the strengths and talents of each GoHealth team member, creating an environment of involvement, respect and connection where the richness of ideas, backgrounds and perspectives are harnessed. 
• Courage & Integrity: Models and practices the highest ethical and professional standards; demonstrates pride and personal interest in our patients, partners and fellow team members, deeply engaging in the business. Makes decisions, with a focus on doing the right thing; treats team members, our customers, partners and vendors with dignity, consideration, open-mindedness and respect. 
• Accountability: Always shows initiative, demonstrates a bias to action and gets things done. Actively accepts responsibility for diverse roles, obligations and actions that positively influence patient and customer outcomes, our partnerships and the healthcare needs of our communities.

GoHealth Leadership Principles 
GoHealth’s Leadership Principles, listed below, are essential functions for this position: 
• Create Shared Purpose: Breathe life into our vision and mission. Speak to our future and create a line of sight for our team members. Set goals and communicate a plan of action. Empower others to deliver. 
• Inspire and Motivate: Celebrate and share success. Grow and develop our team members. Provide direct feedback that enables others to reach their potential. Identify when to lead and embrace the opportunity to follow. 
• Plan, Execute, Adapt and Deliver: Leverage analytics and experience to make better decisions. Possess a bias towards action and manage risk. Be agile, pragmatic and adjust. Identify, acknowledge, plan, implement and follow-up. 

Physical Requirements 
• Office Environment: Tasks may be conducted within a climate-controlled office setting. 
• Physical Activity: The role may require the ability to lift, carry, push, or pull materials, supplies, and equipment (up to 25 lbs.) Duties typically involve a combination of sitting, standing, and walking, with frequent changes in position. 
• Travel: Travel may be required, including travel between facility locations, remote facilities, and out-of-town destinations as needed. 
• Safety Equipment: May require the use of safety equipment for infection prevention.

Note: This Job Description is not inclusive of all the duties of the position. You may be asked by Leaders to perform other duties. Leadership may revise this job description at any time. 

Equal Employment Opportunity Statement 
The Company and its affiliates, joint venture partners and entities under common management are Equal Opportunity Employers. They do not discriminate based on race, color, religion, national origin, age, sex, disability, veteran status, sexual orientation, gender identity, or any other protected status under federal, state, or local law. 

ADA Accommodation Statement 
Reasonable accommodations are available for qualified individuals with disabilities upon request. This role defines success by achieving essential function outcomes, not by the method of completion. 

Compliance Statement 
This job will be performed consistent with ADA, FMLA, FLSA, and other applicable federal, state, and local laws regulating employment.

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All qualified persons are granted an equal opportunity for employment without regard to race, color, religion, sex, sexual orientation and gender identity or expression, age, national origin, citizenship status, disability, genetic information, medical condition, family care leave status, pregnancy or pregnancy-related condition, otherwise qualified disabled or veteran status. The company will comply with all fair employment laws in each of the jurisdictions where we conduct business.

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