Electronic Data Interchange Specialist (Medical Clearing House)
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!
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.
High School diploma or GED required
Associates degree in related field preferred
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
• Ability to communicate effectively to patients about their medical conditions and the financial aspects of
• Ability to communicate effectively to patients, centers, and staff regarding departmental policy
• Ability to type proficiently
• 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 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.