Overview

Inpatient Revenue Cycle EDI Specialist

Competitive Hourly Rate

ON-SITE

BONUS ELIGIBLE

Are you results-oriented? Our dynamic team has the responsibility of resolving outstanding insurance claims so that our patients are not impacted.

We offer an exceptional employee experience, full-time hours, full benefits, paid training, and advancement opportunities. Our team offers flexible, first shift, Monday through Friday schedules. This would include two fifteen minute breaks and one half-hour lunch. We allow for casual work attire, jeans are our norm!

The person in the above position will directly report to either the Billing Supervisor or Billing Manager. This position will maintain the Electronic Data Interchange (EDI) Clearinghouses and eligibility verification systems used by the Inpatient Billing Team to ensure that the claims are billed correctly and efficiently. The position requires an ability to quickly learn and understand the goals of the Billing Team and the processes used for their daily work. The ideal candidate should be able to work with little or no supervision, always taking the initiative to find areas for improvement within the CBO.

Responsibilities

• Familiarity with standard ANSI transactions including .837i claim, .270/.271 eligibility and .276/.277 claim status.

Electronic claims:

• Maintain Billing and EDI information within the Patient Accounting System and with multiple claim Clearinghouses.
• Review daily claim reconciliation to ensure all claims from the Patient Accounting System transmit to the Clearinghouses.
• Submit and maintain EDI claim enrollments for new payers and new hospitals.
• Conduct investigations to resolve invalid or improper claim rejections. Analyze payer claim rejections to identify opportunities to implement new routines or processes.
• Work with Clearinghouse and/or insurance EDI personnel to resolve claim processing issues.
• Identify, maintain and request claim routines with the Clearinghouses which ensure claims are billed appropriately.
• Maintain documentation on which claim routines are in place within each Clearinghouse including what the routine does and why it is needed.
• Utilize data analytic tools identify trends and opportunities for improvement with biller processes and EDI claim submission.

Electronic Eligibility:

• Maintain eligibility verification programs including but not limited to adding payers and ensuring active connectivity.
• Familiarity with Eligibility Batch files frequency and ensuring the files process timely.
• Review any eligibility that is not matched to a payer in the Eligibility programs and update the connection

Communication and Collaboration within the Central Business Office:

• Work with other departments Management to identify trends with payer denials, determining causes and implementing changes.
• Create and maintain resources to assist Billers in resolving claim rejections.
• Review communications from Clearinghouse and Eligibility Verification programs to identify potential concerns or updates and alert affected parties of the impact on the CBO processes and functions.

Qualifications

• Minimum two years’ experience Billing Electronic claims.
• High School Diploma required
• College Degree is preferred.

• Excellent problem solving skills
• Good interpersonal, oral and written communication skills.
• Strong organizational skills with an ability to prioritize to meet deadlines and manage multiple projects.
• Ability to work independently with minimal instruction or supervision
• Required to be proficient in Windows based office technologies (ex. Word, Excel, PowerPoint).

Additional Data

Select Medical strives to provide our employees with a solid work-life balance, as we understand that happy employees have both fulfilling careers and fulfilling lives beyond our doors.

• An extensive and thorough paid orientation program.
• Paid Time Off (PTO) and Extended Illness Days (EID).
• Health, Dental, and Vision Insurance; Life insurance; Prescription coverage.
• A 401(k) retirement plan with company match.
• No Required Weekends

Working Conditions/Physical Demands:

• Office Environment
• Sitting for extended periods of time
• Ability to lift weight up to 35 lbs.