Billing Claims Analyst (EDI Specialist)

The Billing Claims Analyst is responsible for ensuring daily charges are invoiced and claims transmitted, daily charge reconciliation, communication with Billing teams and clinical operations to resolve open charges, end of month closing. Candidate to ensure resolution of claims in the clearinghouse. Monitors the Electronic Data Interchange (EDI) transactions, implements changes as needed, communicates with system vendors using technical support to find resolution. Works with claims and payment teams on the HIPAA 837 -Health Care Claim and 835-Health Care Claim Payment/Advice. Develops and implements the Denials management process utilizing 276/277 claims status inquiry and response, and 278 referral/prior authorization transactions. This position will have responsibility for planning, implementing and managing EDI projects relating to the EDI transactions, including end-user contact, analysis, design, mapping, programming, training and documentation. Ideal candidates require end-to-end revenue cycle experience in order to successfully fulfill the job responsibilities.

Office Location: This position is classified as a hybrid or in-person role for our Corporate HQ in Phoenix, AZ

Compensation: $65,000-$70,000

Responsibilities

• Ensures charges are invoiced and claims transmitted within a 72 hr turnaround from date of service.
• Manage to KPI’s of 10 day Charge lag and 90% first time out claim acceptance. 
• Monitors EDI rejections and identifies issues with claims transmissions, payors, denials, payments, and/or clearinghouse integration.
• Update systems and payors with address and Business changes i.e. W9, remit to addresses, NPI, taxonomy codes etc. 
• Research and analyze billing requirements to ensure all data fields are mapped and converted correctly in X12 ANSI inbound/outbound file.
• Initiates test EDI transactions prior to implementation in a live environment. Initiates meetings with revenue cycle teams to share changes, updates, provides SOP’s to standardize processes for max accuracy and efficiency. 
• Customize the provider inbound/outbound EDI transactions based on specific payer edits/requirements received in responses.
• Make recommendations to streamline tasks and build effective workflows. 
• Devise solutions and provide status to revenue cycle leadership throughout the EDI implementation process.
• Set up new payer/ connections, test and launch
• Manage payer website logins, grant new access, deactivate access and provide password resets for revenue cycle management teams.
• All other assigned duties. 

Qualifications

• REQUIRED: Five (5) years experience in Charge Capture and Claims management. 
• Five years experience in Healthcare revenue cycle, Practice Management Systems support or other related functions.
• Minimum 2 yrs hands-on with EDI transaction sets i.e., 837, 835, 276, 277
• Knowledge of Coding and physician documentation a plus. 
  • CPC Certification or other medical coding certification preferred.
• Experience with Work Comp, Physical Therapy payors preferred. 
• Proficient in Microsoft Office, Excel (advanced formulas, pivot table use), PowerPoint, Word, Outlook, and SmartSheet navigation.
• High school diploma or GED required. BA/BS preferred.
• Previous experience in electronic clearinghouse platform use and navigation