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Job Code: 25537-124588
Parallon believes that organizations that continuously learn and improve will thrive. That's why, after more than a decade, Parallon remains dedicated to helping hospitals and hospital systems operate knowledgeably, intelligently, effectively and efficiently in the rapidly evolving healthcare marketplace, today and in the future.
As one of the healthcare industry's leading providers of business and operational services, Parallon is uniquely equipped to provide a broad spectrum of customized services in the areas of revenue cycle, purchasing, supply chain, technology, workforce management and consulting.
Parallon's purpose is simple. We serve and enable those who care for and improve human life in their communities.
JOB TITLE - EDI Specialist
GENERAL SUMMARY OF DUTIES - Processes and distributes reports, processes claims electronically and enrolls providers.
SUPERVISOR - EDI Manager or Director EDI/Billing/Imaging
DUTIES INCLUDE BUT ARE NOT LIMITED TO:
1. Works claim edit reports, insurance edits routes to appropriate person.
2. Performs weekly QA of the Medic X to X report (showing claims rejected during fast claim processing) to ensure all claims have been corrected and re-filed.
3. Reviews Fast Claim reports to determine-provider eligibility for electronic processing.
4. Sends requests for information or correction to the practice or CBO personnel. Follows up on timely receipt of information. Reports delays to EDI Manager or Director of EDI/Billing/Imaging.
5. Reports to EDI Manager or Director of EDI/Billing/Imaging when all eligible payors need set up for EDI in the billing system.
6. Ensures all claims are be processed and confirmed electronically for assigned practices.
7. Tracks EDI errors utilizing Fast Claim/Fast Note reports MedUnite and ProxyMed reports as well as QA information provided by the billing staff. Presents error reports to the EDI Manager for review and problem
8. Practice and adhere to the Code of Conduct philosophy and Mission and Value Statement .
KNOWLEDGE, SKILLS, & ABILITIES - This position requires the following minimum requirements:
QUALIFICATIONS - To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION and/or EXPERIENCE
One year certificate from college or technical school; or at least one year of medical billing related experience and/or training; or equivalent combination of education and experience.
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry.
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.
PHYSICAL DEMANDS - The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Staff must remain flexible and available to provide staffing assistance for any/all disaster or emergency situations. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee is occasionally required to stand and walk. The employee must regularly lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, color vision, and ability to adjust focus.
Last Edited: 09/15/2016