Overview
This role is seeking candidates who specialize in EDI analytics and ERA/EFT Enrollments, we are not seeking developers and/or designers, thank you!
As an EDI Analyst, you will be responsible for the development, implementation and ongoing maintenance of the Electronic Data Interchange (EDI) transactions including HIPAA 270/271 eligibility inquiry and response, 276/277 claims status inquiry and response, and 278 referral/prior authorization transactions.
The EDI Specialist works with claims and payment teams on the HIPAA 837 -Health Care Claim and 835-Health Care Claim Payment/Advice. The EDI Specialist will work collaboratively with information systems staff, government and third-party payers, clearinghouses, and Nextgen technical support personnel to implement these transactions in an integrated, efficient, and cost-effective manner.
This position will have responsibility for planning, implementing and managing HIPPA EDI projects relating to these transactions, including end-user contact, analysis, design, mapping, programming, training and documentation.
Ideal candidates will require a certain level of revenue cycle management experience in order to successfully fulfill the job responsibilities.
This position has the potential to be remote in the following states: Arizona, Nevada, California, New Mexico and Texas.
Responsibilities
- Setup and Complete EDI registration for all EDI products, including facilitating payer-specific enrollments, until payer grant approval.
- Install and Configure healthcare electronic data interchange applications on provider's network and/or billing stations.
- Research and analyze providers' billing requirements to ensure all data fields are mapped and converted correctly in X12 ANSI inbound/outbound file.
- Initiates test EDI transaction prior initial implementation live environment.
- Conduct post-live support for 6 to 8 weeks by monitoring and assessing the overall usage of EDI products, and conducting weekly follow-up calls with billing administrators to ensure accuracy
- Customize the provider inbound/outbound EDI transactions based on specific payer edits/requirements received in responses.
- Make recommendation on additional resources and feature that adds leverage to EDI product and provides efficient solutions to the practice business operations.
- Devise solutions and provide status to revenue cycle leadership throughout the EDI implementation process on a bi-weekly basis.
- Serve as liaison between provider and healthcare trading partners regarding EDI inquiries including rejections with enrollment, claims, payments, and/or clearinghouse interfacing.
- Setup new payer/ connection setup, testing, and launch.
- Research and analyze new payer requests and submit to EDI QA/Development team to program accordingly.
- Maintains and update remit address changes with government and commercial payers weekly, monthly or quarterly
- Manage payer website logins, grant new access, deactivate access and provide password resets for revenue cycle management teams.
- Formal testing methodology, test plan development and execution, and documentation of test results
- All other assigned duties.
Qualifications
REQUIRED:
- Minimum five (5) years experience in Healthcare revenue cycle management (Payment Posting, Patient Access).
- A minimum of 2-3 years experience with hands-on involvement relative to ANSI X12 Healthcare EDI transaction sets (837, 999, 277CA, 276/277, 835)
- Experience with ERA/EFT enrollments from a hands-on analyst or role perspective.
- Prior EDI or System implementation and Transaction Mapping experience
- Experience in NextGen EHR system, or other healthcare EHR software.
- Proficient in Microsoft Office, specific but not limited to Excel (advanced formulas, pivot table use), PowerPoint, Word, Outlook, and SmartSheet navigation.
- High school diploma or GED required.
- BA/BS in Information Technology, Computer Science, Computer Engineering, equivalent is preferred.
- Previous experience in clearinghouse platform use and navigation, e.g. Waystar, Change Healthcare.