Overview:
We have a RCM EDI Services Analyst Career opportunity for an experienced professional to join our team at Pediatrix Medical Group. We are a national organization, and one of the nation's largest providers of prenatal, neonatal and pediatric services.
Talented business professionals from diverse backgrounds choose Pediatrix because we are an exciting and innovative company that focuses on a team approach to improve the lives of patients everywhere. We are confident that you'll love being a part of the Pediatrix team.
Responsibilities:
The (Remote) RCM Analyst I, EDI Responsible for analyzing, researching and resolving issues related to the creation and submission of paper and electronic claims. Works with the Business Systems Department to create effective clearinghouse edits which respond to errors generated from electronic claims submissions. Monitors claim errors until resolved. Identifies opportunities for new edits based on billing analysis.
Retrieves, researches and resolves all front-end rejections from clearinghouse vendor. Investigates and resolves carrier edits / error within the billing system. Makes necessary corrections and re-bills the claim timely.
Within established Standard Operating Procedures, clearly and completely document all information relevant to claim error reviews and corrections in the patient accounting system consistent with permanent legal records.
Interacts and communicates with Provider Enrollment to resolve outstanding issues. Coordinates with the PE Department to ensure re-bills are sent for providers following enrollment completion.
Notifies the Collections Management Team of any unusual or large volume payer trends / denials.
Works with updating insurance information for claims that need to be re-billed.
Preforms other job-related duties within the job scope as requested by Management.
Qualifications:
High school diploma or general education degree (GED); or equivalent combination of education and experience.
Preferred: Healthcare or Revenue Cycle Management experience.
Basic Microsoft Office experience.
Ability to communicate both verbally and written.
Ability to effectively present information and respond to questions from customers and vendors.
Ability to read, analyze, and interpret general business documents, technical procedures and governmental regulations. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Ability to define problems, collect data, establish facts, and draw valid conclusions.
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
Ability to calculate figures and amounts such as discounts and percentages.
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