EDI Billing Specialist - FUTURE OPPORTUNITIES

​Accepting resumes for future opportunities.

Responsible for timely daily claim submissions and file maintenance functions of the business office in accordance with RC Billing standards and Reimbursement policy and procedures, including patient billing/EPS, claim submissions electronic and paper, and file maintenance.  Is responsible for seeking resolution to problems relating to timely and efficient claim submissions while ensuring excellent communication between the AR department, CBO management, Revenue Cycle IT Department and the Revenue Cycle Credentialing Department while ensuring client satisfaction. Responsible for timely completion of all client Allscripts Tiger database file builds and Practice Insight file builds to include documentation and follow-up processes through to completion.  Responsible for daily file maintenance within Allscripts Tiger and Practice Insight.  Responsible for ensuring daily claim submissions for all clients are successful and monitoring denials to ID trends and/or resolution is being sought timely by the AR Department.   Responsible for balancing, daily/monthly closing of all databases and preparing month end reporting packages. ​

ESSENTIAL DUTIES AND RESPONSIBILITIES: 
 

• Ensures that daily, weekly, and monthly Insurance AR and Patient AR billing functions are performed as scheduled and accurate. 
• Demonstrates thorough understanding of claim submission function compliant with Federal and State regulations and RC Billing policy and procedures. 
• Ensures daily receipt and accurate balancing of clearinghouse EDI reports and Payer reports. 
• Ensures timely daily resolution of Clearinghouse EDI edit report and Payer edit report and claims are re-queued for timely claim submission. 
• Prepares and maintains the Daily Claim Submission Log per client ensuring all claims are received at the clearinghouse and payer levels for adjudication. 
• Ensures that all claims are submitted via electronic for all payers accepting electronic submissions.   
• Notifies Credentialing/Contracting Department and management of any clearinghouse enrollments (EDI & ERA) necessary to accomplish electronic submission and electronic remit advice for existing and new clients. 
• Prepares and maintains the Daily Patient Statement Log per client. 
• Completes month end close processes as assigned and recognizes this position requires overtime and no PTO during month end close schedule. 
• Reports any and all claim submission and/or file maintenance issues/concerns to the CBO management. 
• Notifies Credentialing/Contracting Department of any physician and/or payer credentialing issues for resolution. 
• Completes initial database build and maintains database file builds for all clients. 
• Completes initial setup in Practice Insight for each client and physician and maintains going forward. 
• Ensures strong communication between CBO management team, Revenue Cycle IT and Credentialing Departments and promptly responds to any and all high priority issues with immediate response and planned resolution.  
• Ensures compliance with RC Billing Reimbursement Policies and Procedures to maximize efficiency.  Ensures compliance with appropriate industry regulations and State and Federal regulations. 
• Maintains working day to day knowledge of the practice management system. 
• Maintains working knowledge of applicable laws and regulations as they relate to assigned responsibilities. 
• Maintains confidentially of all information related to patients, medical staff, finances and cost effective health care delivery issues. 
• Strives to achieve and maintain company Days Sales Outstanding and Account Receivable Aging standards. 
• Strives to achieve CBO goals. 
• Additional duties as assigned. 

 
EDUCATION AND/OR EXPERIENCE: 
 

• High school diploma or equivalent.   

• Minimum four (4) years applicable medical CBO experience. 

 
QUALIFICATIONS: 
 

• Knowledge of organization policies and procedures. 

• Knowledge of health care administration principals. 

• Knowledge of business office procedures. 

• Knowledge of insurance agency operating procedures and practices. 

• Skill in exercising initiative, judgment, discretion and decision -making to achieve business unit objectives.  Skill in identifying and resolving problems.   

• Ability to communicate effectively and professionally.   

• Ability to establish and maintain effective professional working relationships with all employees and clients. 

•    Knowledge of CPT-4 and ICD-9/ICD-10 coding.   

• Knowledge of Allscripts, Allscripts Pro PM, Misys/Tiger and Practice EDI Insight preferred.  

• Ability to communicate effectively orally and in writing. 

 
CERTIFICATIONS / LICENSURES / CREDENTIALS:  
 

• None  

 
SUPERVISORY RESPONSIBILITIES:   
 

• None 

 
PHYSICAL DEMANDS: 
 
The physical demands described are representative of those that must be met by an employee to successfully perform the essential functions of this position.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.  This position requires full range of body motion including manual and finger dexterity and eye-hand coordination.  The position additionally requires standing/sitting for extensive periods of time.  Occasional lifting and carrying items weighing up to forty (40) pounds may be required.  Requires corrected vision and hearing to normal range. 
 
WORK ENVIRONMENT: 
 
The work environment characteristics described are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work is performed in an office environment involving frequent interaction with staff, clients and the general public. 
 
As part of our commitment to cybersecurity, we require all employees who work remotely or need access to our internal systems to connect to our VPN. To facilitate this, all employees are required to download and install the company-approved multifactor authentication app (DUO) on your mobile device.  ​