EDI Billing Specialist, Hosp
About The Position
Under the leadership of Patient Financial Services (PFS) management, the EDI Billing Specialist is responsible for timely and accurate billing of all claims for physician and/or hospital services and may include patient services identified as "Special Billing, including client, clinical trials, international, purchased services, occupational health, solid organ and BMT services. Monitor, direct, or correct all unbilled and pending claim rejections. The EDI Billing Specialists objective is to develop, coordinate, implement, and manage electronic claims rejections. Additionally, the EDI Billing Specialist serves as the primary link between the business and all data-trading partners (client, claims processing, clearinghouse and other data providing or receiving partners); Day to day responsibilities include establishing contact with trading partners, analyzing the data exchanged with any partners, observing data records to record any errors, and correcting any failures and staging the received data for billing operations use. Working with all levels of the organization to support accurate, proper data exchanges within the organization.
Requirements
- High School Diploma or equivalent required, Bachelors preferred
- Minimum three years relevant work experience in hospital billing/coding or healthcare business office experience
- Must possess an advanced knowledge of various types of insurance plans
- Understanding of Managed Care contracts, denials and payor methodology
- Must have thorough knowledge of billing invoicing practices such as CMS UB and EDI (Electronic Data Interchange)
- Expert with clearinghouse rejections, demographics, and modifiers
- Ability to work in fast paced, deadline driven environment
- Effective oral and written communication skills
- Keyboarding accuracy and math aptitude skills
- Medical terminology, knowledge of insurance and reimbursement procedures preferred
- Prior experience with Epic Hospital Billing Resolute preferred
Responsibilities
- timely and accurate billing of all claims for physician and/or hospital services
- Monitor, direct, or correct all unbilled and pending claim rejections
- develop, coordinate, implement, and manage electronic claims rejections
- serves as the primary link between the business and all data-trading partners
- establishing contact with trading partners
- analyzing the data exchanged with any partners
- observing data records to record any errors, and correcting any failures and staging the received data for billing operations use
- Working with all levels of the organization to support accurate, proper data exchanges within the organization
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
