EDI Specialist

Atlanta, Georgia  | Billing

Description

Position at GoHealth Urgent Care

GoHealth Urgent Care partners with healthcare systems across the country to provide unparalleled experiences for our customers, employees, partners and community. We live our values of innovation, collaboration, diversity/inclusion, courage/integrity and accountability. We believe in promoting from within and the value of each team member. Check us out as we are growing and in need of professionals whose mission and values coincide with GoHealth!

JOB SUMMARY

The Electronic Data Interchange (EDI) Specialist is responsible for identifying, resolving and maintaining system edits using EPIC, E-Clinical Works and the market specific clearinghouse. This individual will review and track claim rejections to identify and resolve existing or potential issues that would impact efficient and accurate claims adjudication and/or claim status.

JOB REQUIREMENTS

Education

 High School diploma or GED required
 Associates degree in related field preferred

Work Experience
 2+ years of related experience and/or training required
 Experience working claim edits
 Clearinghouse experience required

Required Licenses/Certifications: None 

Additional Knowledge, Skills and Abilities Required
• Knowledge of governmental and commercial insurance billing requirements.
• Understanding of the revenue cycle workflow.
• Ability to effectively manage competing priorities, and a sense of urgency.
• Demonstrated ability to work independently, take initiative and be self-motivated.
• Ability to work in fast paced, deadline driven environment.
• Possess excellent organizational and follow up skills, with a strong attention to detail

Customer service skills:
• Ability to represent the Department in a professional manner when interacting with patients, guests,
physicians and their staff
• Ability to handle service issues professionally
• Ability to follow through with customers

Communication Skills:
• Ability to communicate effectively to patients about their medical conditions and the financial aspects of
their care.
• Ability to communicate effectively to patients, centers, and staff regarding departmental policy

Keyboard skills:
• Ability to type proficiently

Teamwork:
• Ability to function effectively as extension of the Center
• Be flexible and open-minded in thought processes
• Maintain focus under pressure
• Share relevant information with other team members

Medical Terminology & Insurance
• Ability to understand basic medical terminology
• Ability to calculate deductible and co-insurance correctly
• Ability to read and understand carrier Explanation of Benefits

Additional Knowledge, Skills, and Abilities Preferred
 Epic or eClinicalWorks experience
 Experience with Microsoft Word and Excel

ESSENTIAL FUNCTIONS
Essential functions are those tasks, duties and responsibilities that comprise the means of accomplishing the job’s purpose and objectives. Essential functions are critical or fundamental to the performance of the job. They are the major functions for which the person in the job is held accountable. Following are the essential functions of the job.