Summary: The EDI Specialist is responsible for directing all unbilled and pending claim rejections to the respective practice work queue for data entry corrections. The EDI Specialist's main objective is to develop, coordinate, implement, and manage electronic claims rejections. Additionally, the EDI 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); The EDI Specialist 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. EDI Specialists work with employees at all levels of their organization to support accurate, proper data exchanges within the organization. They assist with any testing to observe and interpret messages received and offer updates to their supervisor, typically a departmental lead or supervisor.
High School education or equivalent.
Must possess an advanced knowledge of various types of insurance plans; CPT, ICD, HCPCS Level II coding guidelines, and an understanding of the nuances of payer claim requirements.
Strong understanding of professional claims invoicing practices such as CMS 1500 and EDI (Electronic Data Interchange).
Must have thorough knowledge of billing and payer claims requirements (commercial and government).
Two years' relevant work experience or education in healthcare billing/coding a plus.
Solid Microsoft Office (Excel, Word, PowerPoint) skills.
Expert with clearinghouse rejections, demographics, and modifiers.
Highly prefer supervisory or team lead experience, with a thorough understanding of the revenue cycle workflow.
Demonstrated ability to work independently, take initiative and be self-motivated.
Strong communication skills, both verbal and written.
Possess excellent organizational and follow up skills, with a strong attention to detail.
Medical billing experience with a physician billing office.
Expert knowledge of governmental and commercial insurance billing requirements.
Ability to effectively manage competing priorities, and a sense of urgency.
Ability to work in fast paced, deadline driven environment.