Hotline: 678-408-1354

The Electronic Data Interface (EDI) Claims Specialist (or clearinghouse specialist) will work with Netsmart and its clients to provide expertise in the data exchange and client account set up to facilitate billing and revenue collection. The individual will utilize previous knowledge in billing and accounts receivable in a Hospice, Home Health and Palliative Care environment to support the electronic and billing processes through the technology and software programs. The Specialist will work closely with teammates and clients for the setup, testing and implementation of EDI transactions.

Essential Duties and Responsibilities include the following. Other duties may be assigned:

  • Verify accuracy of billing data
  • Research and revise errors in processes or claims
  • Maintain detailed records
  • Interact with staff, payer and Agencies to answer questions, obtain information, and resolve issues.
  • Monitor clearinghouse reports and take such steps necessary to guarantee payment of claims.
  • Coordinate and collect necessary information from staff or payers for claim adjudication.
  • Recognize problem accounts and notify appropriate staff or supervisor to assist in problem resolution.
  • Anticipate insurance trends and advise supervisor of changes.
  • Assist in the creation of manuals and protocols.
  • Act as back-up coverage for associates as needed.
  • Maintain open and positive team-oriented lines of communication with Manager and other staff members.

Qualifications

  • Previous experience with billing software and/or experience billing out of an Electronic Health Record System
  • Previous accounts receivable experience preferred
  • Previous clearinghouse (Electronic Data Interchange) knowledge or EDI transaction files preferred
  • The ability to work independently
  • The ability to work collaboratively on projects
  • The ability to demonstrate strong customer service skills to create channels of communication and obtain information necessary to perform job tasks, such as working with payers and billing department staff
  • Excellent written and verbal communications skills
  • Outstanding computer skills to include ability to work with .txt files and strong user of Microsoft Word, PowerPoint, Excel, Outlook
  • Outstanding attention to detail
  • Excellent time management skills
  • Crystal Reports (not required but very helpful)
Share this job

Contact Us

Eltas EnterPrises Inc.
3978 Windgrove Crossing
Suite 200A
Suwanee, Georgia
30024, USA
contact@eltasjobs.com

Subscribe to our Newsletter