Electronic Data Interchange (EDI) Claims Assistant

UCSF•Emeryville, CA

About The Position

The Electronic Data Interchange (EDI) Claims Assistant will work in the EDI unit and will be responsible for all aspects of EDI production for UCSF Health Patient Financial Services (PFS), Medical Group Business Services (MGBS), UCSF Benioff Children’s Hospital Oakland (BCH Oakland), By the Bay Health, UCSF Physicians Group, Community Connect clinic, and Community Hospitals. The EDI production supports all electronic claim production to various payers and clearinghouses, including Medicare, Medi-Cal, Medi-Cal MC, Anthem Blue Cross, Blue Shield, Availity, Optum IEDI, Optum Exchange, Jopari, PNT, and Office Ally. Electronic claim generation represents approximately 95% of all claims production. Monthly claims volume processed can reach up to 150,000 claims for hospital billing and up to 400,000 claims for professional billing. The position also supports the Electronic Remittance Advice (ERA) processes for UCSF, MGBS, LPPHC, BCH Oakland, BTBH, UC Physician Group, Community Connect Partners, and Community Connect Hospitals. In addition, this position also supports Electronic Funds Transfer (EFT) processes for UCSF, MGBS, BCH Oakland, LPPHC, UCPG, and Community Hospitals. The ERA/EFT represents approximately 80% of all inbound payment transactions to all supported service areas. Frequent contact with all units in Patient Financial Services and other billing groups, as well as outside entities, such as Health Plans and EDI Clearing Houses, which partner with UCSF in EDI processes. Frequent access to the following applications: EPIC/APeX, Wells Fargo CEO portal, Clearinghouse EDI portals, ApplicationXtender, Cirius’ Billing and Remittance Applications, and various payer sites.

Requirements

Frequent access to the following applications: EPIC/APeX, Wells Fargo CEO portal, Clearinghouse EDI portals, ApplicationXtender, Cirius’ Billing and Remittance Applications, and various payer sites.

Responsibilities

Responsible for all aspects of EDI production for UCSF Health Patient Financial Services (PFS), Medical Group Business Services (MGBS), UCSF Benioff Children’s Hospital Oakland (BCH Oakland), By the Bay Health, UCSF Physicians Group, Community Connect clinic, and Community Hospitals.
Supports electronic claim production to various payers and clearinghouses.
Supports Electronic Remittance Advice (ERA) processes.
Supports Electronic Funds Transfer (EFT) processes.
Frequent contact with all units in Patient Financial Services and other billing groups.
Frequent contact with outside entities, such as Health Plans and EDI Clearing Houses.