EDI Analyst

Job Description

Job Description

Overview

As an EDI Analyst, you will be responsible for the development, implementation and ongoing maintenance of the Electronic Data Interchange (EDI) transactions including HIPAA 270 / 271 eligibility inquiry and response, 276 / 277 claims status inquiry and response, and 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. The EDI Specialist will work collaboratively with information systems staff, government and third-party payers, clearinghouses, and Nextgen technical support personnel to implement these transactions in an integrated, efficient, and cost-effective manner. This position will have responsibility for planning, implementing and managing HIPPA EDI projects relating to these transactions, including end-user contact, analysis, design, mapping, programming, training and documentation. Ideal candidates will require a certain level of revenue cycle management experience in order to successfully fulfill the job responsibilities.

Responsibilities

• Setup and Complete EDI registration for all EDI products, including facilitating payer-specific enrollments, until payer grant approval.
• Install and Configure healthcare electronic data interchange applications on provider’s network and / or billing stations.
• Research and analyze providers’ billing requirements to insure all data fields are mapped and converted correctly in X12 ANSI inbound / outbound file.
• Initiates test EDI transaction prior 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 insure accuracy
• Customize the provider inbound / outbound EDI transactions based on specific payer edits / requirements received in responses.
• Make recommendation on additional resources and feature that adds leverage to EDI product and provides efficient solutions to the practice business operations.
• Devise solutions and provide status to revenue cycle leadership throughout the EDI implementation process on a bi-weekly basis.
• Serve as liaison between provider and healthcare trading partners regarding EDI inquiries including rejections with enrollment, claims, payments, and / or clearinghouse interfacing.
• Setup new payer / connection setup, testing, and launch. Research and analyze new payer requests and submit to EDI QA / Development team to program accordingly.
• Maintains and update remit address changes with government and commercial payers weekly, monthly or quarterly
• Manage payer website logins, grant new access, deactivate access and provide password resets for revenue cycle management teams.
• Formal testing methodology, test plan development and execution, and documentation of test results
• All other assigned duties.

Qualifications

REQUIRED : Minimum five (5) years experience in Healthcare revenue cycle management (patient financial services / patient access).