Summary: The EDI Specialist is responsible for directing all unbilled and pending claim rejections to the respective practice workqueue for data entry corrections. The EDI Specialist's main objective is to develop, coordinate, implement, and manage electronic claims rejections. Additionally, the EDI Specialist serves as the primary link between the business and all data-trading partners (client, claims processing clearinghouse and other data providing or receiving partners); The EDI Specialist day to day responsibilities include establishing contact with trading partners, analyzing the data exchanged with any partners, observing data records to record any errors, and correcting any failures and staging the received data for billing operations use. EDI Specialists work with employees at all levels of their organization to support accurate, proper data exchanges within the organization. They assist with any testing to observe and interpret messages received and offer updates to their supervisor, typically a departmental lead or supervisor.
High School education or equivalent.
Must possess an advanced knowledge of various types of insurance plans; CPT, ICD, HCPCS Level II coding guidelines, and an understanding of the nuances of payer claim requirements.
Strong understanding of professional claims invoicing practices such as CMS 1500 and EDI (Electronic Data Interchange).
Must have thorough knowledge of billing and payer claims requirements (commercial and government).
Expert with clearinghouse rejections, demographics, and modifiers.
Highly prefer supervisory or team lead experience, with a thorough understanding of the revenue cycle workflow.
Medical billing experience with a physician billing office.
Expert knowledge of governmental and commercial insurance billing requirements.
Ability to effectively manage competing priorities, and a sense of urgency.
Demonstrated ability to work independently, take initiative and be self-motivated.
Strong communication skills, both verbal and written
Ability to work in fast paced, deadline driven environment.
Solid Microsoft Office (Excel, Word, PowerPoint) skills.
Possess excellent organizational and follow up skills, with a strong attention to detail.
Two years' relevant work experience or education in healthcare billing/coding a plus.
Cook Children's Health Care System is a not-for-profit, nationally recognized pediatric health care organization comprised of eight entities – a Medical Center, Physician Network, Home Health company, Northeast Hospital, Pediatric Surgery Center, Health Plan, Health Services Inc., and Health Foundation.Cook Children's Medical Center Based in Fort Worth, Texas, the integrated system has more than 6...0 primary and specialty care offices throughout North Texas. Its service region includes Denton, Hood, Johnson, Parker, Tarrant and Wise counties, with an additional referral area encompassing nearly half the state.Cook Children's traces its roots back to 1918, but throughout its continual change and robust growth, it still embraces an inspiring promise – to improve the health of every child in its region through the prevention and treatment of illness, disease and injury. To live up to this promise, Cook Children's combines the art of caring with the use of leading technology and extraordinary collaboration to provide exceptional care for every child, every day.History – Cook Children's has a rich history of nearly a century of caring for children.Our Promise – Knowing that every child's life is sacred, it is the promise of Cook Children's to improve the health of every child in our region through the prevention and treatment of illness, disease and injury.Companies – Based in Fort Worth, Texas, Cook Children's is a not-for-profit organization that is comprised of eight nationally recognized companies.Community Health Outreach – Cook Children's Community Health Outreach works together with over 150 partner organizations to improve the safety and health of at-risk children through education, disease and injury prevention and support.Clinical Research – Cook Children's is home to a skilled team of research-minded physicians, nurses and health care professionals and administrators who drive our commitment to excellent clinical care and the search for medical advances.Public Relations – Cook Children's Public Relations works with national and local media outlets, produces Cook Children's publications, coordinates special events and helps develop key relationships within the community.Contractor & Vendor Information – Cook Children's contractors and vendors must ensure their employees are knowledgeable about working with our organization.Sponsorship guidelines – Cook Children's sponsors a select number of events that are strongly aligned with its promise to improve the health of every child in the region through the prevention and treatment of illness, disease and injury.