This position is responsible for optimizing electronic system capabilities to create higher efficiencies in the claims revenue cycle process. Responsible for creating and optimizing EDI connectivity for claims and ERAs. Ensures all providers and payers are configured correctly for timely claims submission and receipt of remittances.
Configuration of the system to accept ERAs (Electronic Remittance Advices). Validate that the parameters are set up correctly to electronic ally post payments in EPIC. Set up new account and maintain updates/changes to existing accounts.
Audit existing ERA parameters. Identify trends for improved accuracy.
Serve as the primary point of contact to clearinghouse vendors and payer EDI teams.
Work with the IT team to test new connections and troubleshoot issues. Test file submissions to ensure accurate posting, verify that the practice management system is configured to send and receive electronic files. This includes configuration of new as well as maintenance of existing payers.
Works with AR follow-up associates to track denials which are based on configuration issues. Monitors and proactively identifies, researches and proposes solutions to trends.
Running reports and monitors configuration related rejections and denials. Identified trends and proposes solutions to issues identified through report analysis. Drive and maintain industry best practices for eClaims submission.
Located in Broomfield, CO.
Required: High School or Equivalent
Required: Three (3) years of work experience in medical billing, insurance, or claims or three (3) years health care experience with one year including EDI experience.
Preferred: Three (3) years of EDI work experience.
Knowledge, Skills and Abilities:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements list must be representative of the knowledge, skills, minimum education, training, licensure, experience, and/or ability required.
General computer skills; typing, 10-key and MS Office are required. Knowledge of payer and clearinghouse enrollment requirements, in addition to knowledge of 837 and 835 transactions are also required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
SCL Health is a faith-based, nonprofit healthcare organization that operates eight hospitals, four safety net clinics, one children’s mental health center and more than 190 ambulatory service centers in three states – Colorado, Kansas and Montana. The health system includes 15,000 full-time associates and more than 500 employed providers.