Lead Electronic Data Interchange Specialist

Atlanta, Georgia  | Billing

Description

Position at GoHealth Urgent Care

JOB SUMMARY

The key role of the EDI Team Lead is to provide information and support to EDI Specialist in relation to training, claim issues and other identified support. This individual will assist with clearinghouse, provider, ERA and EFT set ups as well as work to support accurate, proper data exchanges to ensure timely responses from payers.

JOB REQUIREMENTS

Education

• High School diploma or GED required
• Bachelor’s degree in Business Administration or related field preferred

Work Experience
• 2+ years of related experience and/or training required
• 1+ year of progressive Healthcare management experience required

Required Licenses/Certifications

Additional Knowledge, Skills and Abilities Required
• Knowledge of billing and payer claims requirements (commercial and government).
• Understanding of the revenue cycle workflow.
• 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

• Customer service skills:
o Ability to represent the Department in a professional manner when interacting with patients, guests, physicians and their staff
o Ability to handle service issues professionally
o Ability to follow through with customers
o Share relevant information with other team members
• Communication Skills:
o Ability to communicate effectively to patients about their medical conditions and the financial aspects of their care.
o Ability to communicate effectively to patients, centers, and staff regarding departmental policy
• Keyboard skills:
o Ability to type proficiently

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

• Medical Terminology & Insurance
o Ability to understand basic medical terminology
o Ability to calculate deductible and co-insurance correctly
o Ability to read and understand carrier Explanation of Benefits
Additional Knowledge, Skills, and Abilities Preferred • Epic and/or eClinical Works experience
• Epremis, Waystar, Trizetto, SSI, Change Healthcare and Relay experience
• Experience with Microsoft Word, Excel, and PowerPoint


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.

• Responsible for assisting with Revenue Cycle’s EDI setup’s as needed. These include provider enrollments, database maintenance, liaison with vendor, test electronic files as needed.
• Responsible as needed for timely completion of all EDI – ERA – EFT forms to include documentation and follow-up processes through to completion and approval with all payors
• Manage eClinical Works and Epic Edit Work Queues and develop processes for daily workflows.
• Works with the team in developing and understanding EPIC and eClinical Works WQs and Clearinghouse processes
• Assist Revenue Cycle Analyst with projects and or issues
• Creates and monitors productivity reports in all markets for EDI Specialist
• Monthly one on one meetings with team members to discuss attendance, productivity and QA, goals and any other needs of the team member
• Trains new EDI Staff
• Maintain a high-level customer service approach to working team members, payors, centers, customers and business partners
• Monitoring assigned markets to achieve Productivity and QA metrics
• Identify any trends and educational opportunities
• Manage On-Boarding process for new employees.
• Complete employee work function set ups including IT, phone, supplies, compliance training, and time clock
• Quarterly performance log review and Annual Performance Appraisal of EDI Specialists
• Complies with Department best practice
• Maintain Daily communication with direct reports.



All other duties as assigned.

Note: this job description is not inclusive of all the duties of the position. You may be asked by leaders to perform other duties. Management reserves the right to revise this position description at any time.