Job Summary- EDI Billing Specialist
- The EDI Specialist is responsible for technical and/or professional claim submissions to all insurance companies, including TPL accounts.
- The EDI Specialist will need to monitor and perform research on unbilled accounts, resolve system edits, and have a good understanding of Clearinghouse responses and be able to resolve rejections.
- The EDI Specialist will effectively communicate with the appropriate departments and external customers in order to ensure clean claim submission.
- The EDI specialist will have a thorough knowledge of billing requirements for paper and electronic claim submissions in order to receive payment for services rendered.
- The EDI specialist requires an understanding of various insurance plans, and payer claim requirements.
Job Responsibilities and Accountabilities
- Responsible for all communication, research, and resolution regarding unbilled accounts, in order to submit clean claims for payment on services rendered.
- Ability to identify, understand, and resolve billing edits in the Host and Clearinghouse systems, as well as responses and rejections from the Clearinghouse system(s).
- Able to perform all billing functions for paper and electronic claim submissions, including entering the required billing data elements within the registration process, as well as basic claim form requirements.
- Manages unbilled/DNB accounts to ensure that charges are being submitted to payers within a timely manner.
- Handles rebills, corrected, and void claims within payer timely filing requirements.
- Demonstrates appropriate, professional level of knowledge to be able to communicate with internal and external customers, including team members and the management team.
- Identifies and resolves any barriers/issues related to claim processing, and appropriately escalate to management as needed.
- Ability to interpret payer Explanation of Benefits and payment information.
- Meets the department’s production and quality expectations in order to meet financial goals.
- Ensures minimal volume of unbilled outstanding charges are present daily; strives to maintain minimal backlog.
Experience, Skills, and Abilities:
- 1-3 Years relevant healthcare experience working with multiple health insurances, medical terminology, CPT, HCPC, and ICD 10 codes
- 1-3 years basic knowledge of UB and/or 1500 electronic and paper billing claim requirements for Hospital or Physician
- 1-3 Years prior facility or professional medical billing or related revenue cycle experience
- Required Skills: Excellent verbal and written communications skills, excellent interpersonal skills, effective analytical and problem-solving skills, ability to work in fast paced, deadline driven environment, ability to operate PC based software programs, knowledge of state/federal healthcare compliance requirements, good organizational and prioritization skills.