Northeast Georgia Health System · 9 hours ago
EDI Specialist - Claims / AR - PRN
Fruitville, FL
Part-time
Onsite
Entry, Mid Level
2+ years expNortheast Georgia Health System is rooted in a foundation of improving the health of our communities. The EDI Specialist is responsible for managing daily electronic data interchange operations to ensure the quality and flow of all EDI transactions.
AssociationCommunitiesFitnessHealth Care
Responsibilities
Monitoring Managed Care Grid to release claims for participating providers appropriately and by payor contract standards
Works with the credentialing department to resolve any provider credentialing issues
Verifies that all provider information is correctly entered in practice management system to ensure correct information is sent on all claims
Assists AR representatives in providing timely file information when needed
Responsible for management of all errors identified through Hosted Claims Manager or scrubber system
Monitor eCommerce dashboard for any EDI alerts pertaining to payor rejections and/or payment remits
Maintains knowledge of all error message codes and able to assist others with denials as needed
Monitor the task queues and assign corrections or errors appropriately
Responsible for sending insurance claims daily and completing reconciliation as noted in the NGPG reconciliation policy and procedure
Manages e Commerce dashboards for acceptance, denials or acknowledgements of claims
Mailing all secondary claims with primary EOB’s attached
Responsible for preparing all patient statements in a timely manner
Responsible for preparing all corporate statements in a timely manner
Works with trading partner and IT department to resolve issues and follows up for satisfactory completion
Must be able to effectively communicate any problems to payor EDI department and resolve
Make manager aware of any problems that could potentially cause a delay in collections for the Revenue Cycle
EDI specialist is responsible for all ERA and EFT applications and set up
Identify trends or problems and offer solutions for resolution and/ or prevention
Qualification
Required
High School Diploma or GED
Two (2) years of experience
Must possess knowledge of EDI X12 transactions and electronic billing systems
Ability to identify data fields and functions on HCFA 1500
In depth knowledge of practice management system functionalities necessary to filing claims and statement billing
Efficiency in analyzing denials and correcting or reassigning accordingly
Familiar with medical terminology and coding
Ability to communicate with other departments both inside and out to resolve any claim issues
Excellent communication skills with trading partners, vendors and payors
Preferred
Knowledge of electronic 835 and 837
Company
Northeast Georgia Health System
Northeast Georgia Health System prides itself on core values, which help us achieve our mission of improving the health of our community.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
C
Carol Burrell
President and CEO
Recent News
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