About this role
Job Category:
Information TechnologyWork Shift/Schedule:
VariesNortheast Georgia Health System is rooted in a foundation of improving the health of our communities.
About the Role:
Job Summary
Manages the daily electronic data interchange operations to ensure the quality and flow of all EDI transactions. The EDI Specialist is responsible for receiving, analyzing and transmitting electronic data utilizing current practice management system.
Minimum Job Qualifications
Licensure or other certifications:
Educational Requirements: High School Diploma or GED.
Minimum Experience: Two (2) years of experience.
Other:
Preferred Job Qualifications
Preferred Licensure or other certifications:
Preferred Educational Requirements:
Preferred Experience: Knowledge of electronic 835 and 837.
Other:
Job Specific and Unique Knowledge, Skills and Abilities
Must possess knowledge of EDI X12 transactions and electronic billing systems
Ability to identify data fields and functions on HCFA 1500
In depth knowledge of practice management system functionalities necessary to filing claims and statement billing.
Efficiency in analyzing denials and correcting or reassigning accordingly.
Familiar with medical terminology and coding.
Ability to communicate with other departments both inside and out to resolve any claim issues
Excellent communication skills with trading partners, vendors and payors
Essential Tasks and Responsibilities
Monitoring Managed Care Grid to release claims for participating providers appropriately and by payor contract standards.
Works with the credentialing department to resolve any provider credentialing issues.
Verifies that all provider information is correctly entered in practice management system to ensure correct information is sent on all claims.
Assists AR representatives in providing timely file information when needed.
Responsible for management of all errors identified through Hosted Claims Manager or scrubber system.
Monitor eCommerce dashboard for any EDI alerts pertaining to payor rejections and/or payment remits.
Maintains knowledge of all error message codes and able to assist others with denials as needed.
Monitor the task queues and assign corrections or errors appropriately.
Responsible for sending insurance claims daily and completing reconciliation as noted in the NGPG reconciliation policy and procedure.
Manages e Commerce dashboards for acceptance, denials or acknowledgements of claims.
Mailing all secondary claims with primary EOB’s attached.
Responsible for preparing all patient statements in a timely manner.
Responsible for preparing all corporate statements in a timely manner.
Works with trading partner and IT department to resolve issues and follows up for satisfactory completion.
Must be able to effectively communicate any problems to payor EDI department and resolve.
Make manager aware of any problems that could potentially cause a delay in collections for the Revenue Cycle.
EDI specialist is responsible for all ERA and EFT applications and set up.
Identify trends or problems and offer solutions for resolution and/ or prevention.
Physical Demands
Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time
Weight Carried: Up to 20 lbs, Occasionally 0-30% of time
Vision: Moderate, Frequently 31-65% of time
Kneeling/Stooping/Bending: Occasionally 0-30%
Standing/Walking: Occasionally 0-30%
Pushing/Pulling: Occasionally 0-30%
Intensity of Work: Frequently 31-65%
Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding
Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals.
NGHS: Opportunities start here.
Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.
Other facts
About Northeast Georgia Health System
Northeast Georgia Health System (NGHS) is a non-profit on a mission of improving the health of our community in all we do. Our team cares for more than 1 million people across the region through five hospitals and a variety of outpatient locations. Northeast Georgia Medical Center (NGMC) has campuses in Gainesville, Braselton, Winder, Dahlonega and Demorest – with a total of more than 1,000 beds and more than 1,500 medical staff members representing more than 60 specialties. Learn more at www.nghs.com.
NGHS includes Northeast Georgia Physicians Group (NGPG), an employed group of more than 700 talented physicians, physician assistants, nurse practitioners, midwives and other clinical staff spanning more than 40 specialties at more than 50 locations across the region.
NGHS is also home to Georgia Heart Institute, the most forward-thinking heart and vascular program in the state and includes one of the largest cardiology practices in the region, including more than 120 clinicians seeing patients at more than a dozen locations. With a multi-disciplinary team of experts treating nearly every type of heart and vascular disease and participating in leading national research, we’re providing advanced care that ensures lasting heart health for generations.
What you'll do
- The EDI Specialist manages daily electronic data interchange operations, ensuring the quality and flow of all EDI transactions, including receiving, analyzing, and transmitting electronic data using the practice management system. Key tasks involve monitoring claims processing, managing errors identified through various systems, and ensuring timely filing of insurance claims and patient/corporate statements.
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