Role Description
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:
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HIPAA 270/271 eligibility inquiry and response
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276/277 claims status inquiry and response
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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. You will work collaboratively with:
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Information systems staff
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Government and third-party payers
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Clearinghouses
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Nextgen technical support personnel
This position will have responsibility for planning, implementing, and managing HIPAA EDI projects relating to these transactions, including:
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End-user contact
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Analysis
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Design
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Mapping
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Programming
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Training
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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
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Setup and complete EDI registration for all EDI products, including facilitating payer-specific enrollments, until payer grant approval.
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Install and configure healthcare electronic data interchange applications on provider’s network and/or billing stations.
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Research and analyze providers’ billing requirements to ensure all data fields are mapped and converted correctly in X12 ANSI inbound/outbound file.
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Initiate test EDI transaction prior to 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.
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Customize the provider inbound/outbound EDI transactions based on specific payer edits/requirements received in responses.
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Make recommendations on additional resources and features that add leverage to EDI product and provide efficient solutions to the practice business operations.
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Devise solutions and provide status to revenue cycle leadership throughout the EDI implementation process on a bi-weekly basis.
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Serve as liaison between provider and healthcare trading partners regarding EDI inquiries including rejections with enrollment, claims, payments, and/or clearinghouse interfacing.
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Setup new payer/connection setup, testing, and launch. Research and analyze new payer requests and submit to EDI QA/Development team to program accordingly.
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Maintain and update remit address changes with government and commercial payers weekly, monthly, or quarterly.
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Manage payer website logins, grant new access, deactivate access, and provide password resets for revenue cycle management teams.
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Formal testing methodology, test plan development and execution, and documentation of test results.
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All other assigned duties.
Qualifications
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Minimum five (5) years experience in Healthcare revenue cycle management (Payment Posting, Patient Access).
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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).
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Experience with ERA/EFT enrollments from a hands-on analyst or role perspective.
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Prior EDI or System implementation and Transaction Mapping experience.
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Experience in NextGen EHR system, or other healthcare EHR software.
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Proficient in Microsoft Office, specific but not limited to Excel (advanced formulas, pivot table use), PowerPoint, Word, Outlook, and SmartSheet navigation.
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High school diploma or GED required. BA/BS in Information Technology, Computer Science, Computer Engineering, or equivalent is preferred.
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Previous experience in clearinghouse platform use and navigation, e.g. Waystar, Change Healthcare.
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