EDI Payor Response Specialist

HCA Healthcare • Houston, TX

101d

About The Position

The Electronic Data Interchange (EDI) Payor Response Specialist is responsible for applying a fundamental knowledge of healthcare billing practices and procedures related to researching, analyzing, and resolving responses from payors. This job has regular contact with internal and external customers and requires regular outreach to payors. In this role you will perform claim research and analysis to resolve payor responses (i.e. 276/277 transactions and 835/Explanation of Benefit (EOB) Claim Adjustment Reason (CAS) codes) in accordance with department policies and procedures. You will initiate telephone calls to payors with respect to claim errors, provider enrollment, patient eligibility, and claim status, utilizing proper customer service protocol. Additionally, you will review correspondence received and perform appropriate action to resolve, meet and maintain established departmental performance metrics for production and quality, and maintain working knowledge of workflow, systems, and tools used in the department.

Requirements

• High school diploma or GED preferred.
• Minimum one year related healthcare experience preferred, such as professional medical/billing, insurance follow-up, or accounts receivable follow-up. Relevant education may substitute experience requirement.
• Prior experience reading and interpreting Explanation of Benefits (EOB) preferred.

Responsibilities

• Perform claim research and analysis to resolve payor responses (i.e. 276/277 transactions and 835/Explanation of Benefit (EOB) Claim Adjustment Reason (CAS) codes) in accordance with department policies and procedures.
• Initiate telephone calls to payors with respect to claim errors, provider enrollment, patient eligibility, and claim status, utilizing proper customer service protocol.
• Review correspondence received and perform appropriate action to resolve.
• Meet and maintain established departmental performance metrics for production and quality.
• Maintain working knowledge of workflow, systems, and tools used in the department.

Benefits

• Comprehensive medical coverage that covers many common services at no cost or for a low copay.
• Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
• Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
• Free counseling services and resources for emotional, physical and financial wellbeing.
• 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service).
• Employee Stock Purchase Plan with 10% off HCA Healthcare stock.
• Family support through fertility and family building benefits with Progyny and adoption assistance.
• Referral services for child, elder and pet care, home and auto repair, event planning and more.
• Consumer discounts through Abenity and Consumer Discounts.
• Retirement readiness, rollover assistance services and preferred banking partnerships.
• Education assistance (tuition, student loan, certification support, dependent scholarships).
• Colleague recognition program.
• Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence).
• Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Hospitals
• Education Level: High school or GED