EDI Specialist Location:Plano, TX

Plano, TX

100,000 - 200,000

ESSENTIAL DUTIES/RESPONSIBILITIES:

Processes electronic claims and eligibility files and loads files into the claims processing system.
Communicates with vendors and clients regarding day-to-day EDI transactions.
Monitors, reports and tracks error trends to manage resolution initiatives.Works under direction of the Director of Revenue Cycle on testing and implementation of new files and-or file changes.
Assists with the testing of new releases on the claims processing system and trouble shoots problems prior to loading into production.Assists with projects including group and vendor implementations and data projects.
Generate, review and process specific EDI documents: 276 and 277 files.
Responsible to reconcile uploaded records with submitted records to ensure data accuracy and follow up with rejected records and/or files.
Responsible for communicate with trading partners via email or phone for data errors and file rejects information, and follow through re-submission activities.
Catalog and maintain and EDI processing log for each individual Trading Partner that submits claims electronically.
Maintain and Track each submitted file for completion of data upload and follow up activities.
Provide information in response to the requests of EDI submitter, patient, physician, insurance company or co-worker as appropriate.Prepare and interpret appropriate statistical reports.Perform any other duties as may be assigned.SPECIFIC

DUTIES/RESPONSIBILITIES:

Prompt response to e-mail and telephone calls.Exceptional interpersonal skills.
Excellent analytical and problem solving skills.
Excellent communicationExcellent organizational skills.
MUST be detail oriented.Assists Patient Account Biller/Collector/Payment Poster/CSR as required or assigned.Adhere to the health insurance portability and Accountability Act HIPAA.EDUCATION/EXPERIENCE:High School Diploma or Equivalent Required.1-3 years of experience in medical office working with insurance claims processing involving CPT, HCPCS, ICE-9CM, and CMS regulations.
Familiarity with CMS 1500 and UB04 claim form completion.
Strong analytical, oral, written communication skills.
Familiarity with health insurance and other third party billing practices and guidelines. (ECW)Proficient in Microsoft Word, Excel, Access, and Outlook.Language/Communication/Organizational Skills: Must demonstrate knowledge of skills necessary for communicating with all ages and diverse cultures.
Must be able to assess situations, identify issues/problems and prioritize. Mathematical Skills: Basic Math Reasoning Ability: Uses personal experience, knowledge and other outside resources to make logical decisions to solve problems. Job location: Work is performed in an office setting