Job Purpose
The Medical Biller – EDI Claims Specialist is responsible for managing WCNF EDI charge capture and claim submission processes to ensure timely and accurate billing. This role plays a critical part in the revenue cycle by identifying billing errors, correcting data, and facilitating proper claim submissions to payers.
Key Responsibilities
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Review patient referrals to ensure all charges are captured for each date of service
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Enter charge corrections into the billing system based on office documentation
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Ensure claims are submitted accurately and timely via electronic data interchange (EDI)
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Verify patient demographics and correct errors in the host system as needed
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Confirm that proper authorizations are entered before claim submission
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Analyze and resolve claim issues causing payer payment delays
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Maintain daily productivity and quality metrics as defined by department policies
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Adhere to client-specific billing procedures and regulatory compliance requirements
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Participate in special projects and perform other assigned duties as directed by management
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Interact courteously and professionally with patients, visitors, coworkers, and clients
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Maintain patient confidentiality in accordance with HIPAA standards
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Demonstrate a professional and team-oriented attitude at all times
Qualifications
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High school diploma or equivalent required
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Previous experience in hospital/facility or physician billing preferred
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Experience with EPIC billing system preferred
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Basic knowledge of healthcare claims and coding, including:
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ICD-10, CPT, HCPCS
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LCD guidelines and claim rejections
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Clearinghouse functions and 1500 claim forms
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Familiarity with a variety of insurance plans and billing guidelines
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Strong attention to detail and organizational skills
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Excellent verbal and written communication skills
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Ability to work independently and collaboratively within a team
Working Conditions
Physical Demands:
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Occasionally required to move around the work area
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Must be able to sit for extended periods
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Use of office tools such as computers, phones, and peripheral devices
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Ability to talk, hear, extend arms, and perform manual tasks
Mental Demands:
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Must be able to follow directions, collaborate effectively, and manage work-related stress
Work Environment:
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Minimal noise; typical office setting
Equal Opportunity Employer
Med-Metrix is an equal opportunity employer. We do not discriminate on the basis of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, genetic information, military or veteran status, or any other protected status under federal, state, or local law.