Catholic Health · 15 hours ago
EDI Specialist
Melville, NY
Full-time
Hybrid
Entry Level
$26/hr - $33/hr
2+ years expCatholic Health is one of Long Island’s finest health and human services agencies, committed to providing compassionate care to the community. The EDI Specialist position is responsible for timely and accurate claim submissions to optimize cash flow and reduce accounts receivable, while working collaboratively with the IT team and ensuring compliance with billing regulations.
Health Care
Responsibilities
Using MS Excel, ADS reports, EPIC reports, and OnBase, accountable for daily claim file download and reconciliation between the physician electronic billing systems
Accountable for the daily transmission of electronic billing systems claims for direct and clearing house submissions
Reconciliation of claims billed, held, and in error
Electronic receipt of transmitted claims
Resolution of claims payers would not accept
Accountable for ensuring maintenance of billing system and logs. Including un-transmitted log, open ticket log, department claim issues, and reconciliation reports
Accountable for daily ERA receive and install jobs through electronic billing system, as well as CH jobs to process the files
Accountable for resolution of claims edits, communicating and collaborating with internal and external resources as needed for completion
Accountable to test new software releases with documented test plan
Work directly with the IT team to test and resolve issues with ADS, EPIC and the clearinghouse
Knowledge of Medicare, Medicaid and third party regulations to ensure proper billing and accuracy of system edits
Assist with analysis process for modifying and or upgrading existing system controls and master files
Complete all requests for updates to master files as needed
Provide proof of timely filing on claims to aid in filing appeals
Recommends to management process improvements that will enhance productivity and quality
Accountable for trending increases in payor rejections and researching directly with the carrier via calls and/or the portal
Performs related duties as assigned and unrelated duties as requested
Contributes to and consistently applies Catholic Health policies, procedures, and benefits to all customers and/or employees without discrimination
Employee conducts himself/herself in conformity with the HIPAA Compliance Program and applicable institutional policies and procedures for patient privacy. In addition, employee conducts himself/herself in conformity with the Catholic Health Security policies and procedures
Qualification
Required
High school diploma or equivalent
Knowledge of Medicare, Medicaid and third party billing regulations required
Two years billing experience and working knowledge of coding required
Knowledge of 837 billing file structure and requirements required
Able to make effective, timely decisions based upon sound judgment, data and experience, considering implications and consequences
Must be highly analytical and have strong problem solving skills
Works in an organized manner, uses time effectively
Excellent computer skills required
Must be proficient in electronic billing system and HIS system
Excellent interpersonal communication skills are required for interacting with internal staff, customers and representatives from external departments and agencies
Preferred
Proficient in MS Excel preferred
Knowledge of CPT/HCPCS and ICD-9 preferred
Benefits
Generous benefits packages
Generous tuition assistance
A defined benefit pension plan
A culture that supports professional and educational growth
Company
Catholic Health
When it comes to health care, Long Islanders have a choice.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Sumita Yadav
System Vice President Operations & Cardiovascular Service Line
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