Payor Enrollment/EDI Specialist-Eden Prairie, MN
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POST DATE 9/13/2016
END DATE 10/10/2016
Eden Prairie, MN
JOB DESCRIPTIONAPPLY BioScrip, Inc. is one of the nation's leading specialty home infusion companies! Our focus is clinical excellence and improving the quality of our patients' lives. With over 2,500 employees able to service 46 states, BioScrip has externally-qualified Centers of Excellence built around specific clinical conditions and therapies, as well as Ambulatory Infusion Centers around the country. Ours is a fast-paced dynamic work environment with room for new ideas and opportunities for career advancement. We offer a wide array of welfare benefits as well as Tuition Reimbursement, an Employee Referral Program, and a 401(k) plan with a Company match.
This position reports to the EDI Manager. Focuses efforts on excellent customer service related to the use of Zirmed for eligibility, claims and reporting. Provides technical support for new payor mappings. Responsible for enrollment of payors for ERA to maximize ERA posting in CPR+. Provides ongoing feedback to Reimbursement regarding errors and reports trends. Performs insurance payor audits between CPR+ and Zirmed to ensure accurate claim submission information. Works with Process Improvement Team as part of training initiatives.
To perform this job successfully, an individual must be able to perform each essential function satisfactorily, with or without reasonable accommodation.
1 Monitors and communicates progress on the assigned tasks related to ERA Enrollment process.
2 Responds to inquiries regarding EDI issues with enrollment, claims, payments, and/or clearinghouse activities
3 Manage enrollment notices (approvals and/or rejections) from payers.
4 Contact payers for enrollment follow up or status as necessary
5 Track enrollment process to assure provider enrollment is completed with all appropriate payers
6 Ability to multi-task and manage concurrent assignments with proper follow-ups
7 Respect and maintain HIPAA confidentiality guidelines.
8 Maintains the highest level of confidentiality and integrity when dealing with company's intellectual property.
9 Each employee is responsible for adhering to those performance programs, policies, procedures, guidelines and internal control standards established to guide the operation of the Company.
10 Each employee must be made aware of and understand proper internal control procedures associated with their specific job function as communicated by his/her manager.
11 Each employee is responsible for reporting concerns that he or she may have with respect to deficiencies in internal control.
12 Performs other duties as needed
EDUCATION, TRAINING AND EXPERIENCE REQUIREMENTS
HS Diploma or GED required. Bachelor's degree preferred. A minimum of three years' experience in healthcare billing with a focus on EDI is required. Experience with Zirmed is preferred..
KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED
The requirements listed below are representative of the knowledge, skill, and/or ability required, with or without reasonable accommodation.
* Knowledge of electronic billing.
* Ability to understand insurance contracts for billing purposes.
* Hands on knowledge on healthcare related EDI transactions (e.g. 837, 834, 270, 271, 835).
* Excellent technical and analytical skills, including proficiency with Excel
* Knowledge of HIPAA confidentiality guidelines.
* Maintains the highest level of confidentiality and integrity when dealing with company's intellectual property.
* Ability to work independently under direction of local management.
* Ability to interact appropriately with all levels of management and staff within current organizations and newly acquired companies.
* Excellent verbal and written communication skills.
* Ability to prioritize and handle multiple tasks and projects concurrently.
* Demonstrated knowledge and proficiency in the principles, procedures and best practices related to this position.
* Strong attention to detail.
* System knowledge of CPR+ (all versions) preferred.
* Proficient in MS Office.
Ability to read, analyze and interpret information appropriate to duties and responsibilities assigned. Ability to operate information systems, follow policy, complete required forms, and prepare reports. Ability to effectively present information and respond to questions from patients, and payors.
Ability to perform basic mathematical calculations.
Ability to define problems, collect data, establish facts, and draw valid conclusions.
BioScrip is an equal opportunity employer. All employment decisions are made without regard to age, color, race, ancestry, national origin, disability, genetic information, military status, religion, creed, sex, pregnancy, childbirth, marital status, citizenship, sexual orientation, gender identity, gender expression, legally protected medical condition, or any other basis prohibited by applicable law. Background checks and drug screens are part of our hiring process. Affirmative Action/Equal Opportunity Employer, Minority/Female/Disabled/Veteran.