Parallon believes that organizations that continuously learn and improve will thrive. That's why, after more than a decade, Parallon remains dedicated to helping hospitals and hospital systems operate knowledgeably, intelligently, effectively and efficiently in the rapidly evolving healthcare marketplace, today and in the future.
As one of the healthcare industry's leading providers of business and operational services, Parallon is uniquely equipped to provide a broad spectrum of customized services in the areas of revenue cycle, purchasing, supply chain, technology, workforce management and consulting.
Parallon's purpose is simple. We serve and enable those who care for and improve human life in their communities.
Job Title: EDI Specialist
The EDI Specialist will work closely with the Lead EDI Specialist entering all required billing data elements prior to processing charges for payment. A major function of this position is the submission of claims in order to receive payment for services rendered by the health care provider. The EDI Specialist role requires an understanding of various types of insurance plans, knowledge of CPT, ICD-10-CM, and HCPCS Level II coding guidelines, and an understanding of the nuances of payer requirements, as to not compromise reimbursement. Billers work primarily with clinic personnel and the clearinghouse and must possess an eye for detail and accuracy. The EDI Specialist must have a basic knowledge of rules and regulations applying to the healthcare industry and stay current on compliance issues.
• Understanding of the general principles of billing, types of reimbursement, and code set guidelines.
• Reviewing and preparing claims for electronic and hard copy billing submission.
• Verify the accuracy of standard healthcare codes used by the physicians to classify services.
• Validate data with billing software for accuracy.
• Submit claims to the insurance company meeting established metrics per hour.
• Reviews and corrects claims and charge edits and updates subscriber/demographic information as necessary.
• Knowledge of medical insurance systems, government programs, electronic data exchange, medical documentation, Evaluation and Management, health insurance claim forms, and health insurance policies.
• Expertise in claim tracking and follow-up, a high sense of urgency when filing claims, detail and accuracy while auditing claims as to file a clean claim on the first submission.
• Openly communicate to the Lead EDI Specialist any trends in rejections from the clearinghouse.
• Understanding of the life cycle of a medical billing claim to assist in implementation of solutions to reduce front-end errors and improve the revenue cycle.
• Maintain a professional attitude and act cooperatively and courteously towards patients, leadership, clinical staff, and Home Office employees.
KNOWLEDGE, SKILLS, ABILITIES REQUIRED:
• High School Diploma or equivalent.
• Relevant work experience or education in healthcare billing/coding a plus.
• Knowledge of medical terminology, patient care documentation, CPT, ICD-10-CM, and HCPCS Level II codes.
• Ability to work in fast paced, deadline driven environment.
• Solid Excel and Word skills and a willingness to learn.
• Highly organized team player
• Good verbal and written communication abilities.
• Maintains confidentiality at all times.
• Must be able to pay close attention to details, concentrate on work, and observe the work of others.
• Knowledge of and adherence to HIPAA regulations and guidelines.
• Practice and adhere to the company Mission Statement and Excellence Strategy.
PHYSICAL DEMANDS - The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee is occasionally required to stand and walk. The employee must regularly lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, color vision, and ability to adjust focus.
A little about us:
HCA is the nation’s leading private provider of healthcare services. Comprised of locally managed facilities which include 230,000 employees at over 160 hospitals, over 120 surgery centers and 100 urgent care facilities in 20 states and the United Kingdom