EDI Payor Response Specialist Virtual(Job Number: 25537-153579)
Work Location: United States-Tennessee-Brentwood-Nashville Physician Service Ce
Job Type: Admitting Registration Clerical & Scheduling
Parallon believes that organizations that continuously learn and improve will thrive. That's why, after more than a decade, Parallon remains dedicated to helping hospitals and hospital systems operate knowledgeably, intelligently, effectively and efficiently in the rapidly evolving healthcare marketplace, today and in the future.
As one of the healthcare industry's leading providers of business and operational services, Parallon is uniquely equipped to provide a broad spectrum of customized services in the areas of revenue cycle, purchasing, supply chain, technology, workforce management and consulting.
Parallon's purpose is simple. We serve and enable those who care for and improve human life in their communities.
Electronic Data Interchange Payor Response Specialist
Job Summary – The Electronic Data Interchange (EDI) Payor Response Specialist is responsible for applying a fundamental knowledge of healthcare billing practices and procedures related to researching, analyzing, and resolving responses from payors. This job has regular contact with internal and external customers and requires regular outreach to payors.
Supervisor – EDI Manager
Supervises – None
Duties (included but not limited to)
• Perform claim research and analysis to resolve payor responses (i.e. 276/277 transactions and 835/Explanation of Benefit (EOB) Claim Adjustment Reason (CAS) codes) in accordance with department policies and procedures
• Initiate telephone calls to payors with respect to claim errors, provider enrollment, patient eligibility, and claim status, utilizing proper customer service protocol
• Review correspondence received and perform appropriate action to resolve
• Meet and maintain established departmental performance metrics for production and quality
• Maintain working knowledge of workflow, systems, and tools used in the department
• Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”
• Other duties as assigned
Knowledge, Skills, and Abilities
• Communication - communicates clearly and concisely, verbally and in writing, utilizing proper punctuation and correct spelling
• Customer orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations
• Interpersonal skills - able to work effectively with other employees, patients, and external parties
• PC skills - demonstrates proficiency in Microsoft Office applications and others as required
• Policies & Procedures - demonstrates knowledge and understanding of organizational policies, procedures, and systems
• Basic skills - demonstrates ability to organize, perform and track multiple tasks accurately in short timeframes; able to work quickly and accurately in a fast-paced environment while managing multiple demands; able to work both independently and collaboratively as a team player; demonstrates adaptability, analytical and problem solving skills, and attention to detail; and able to perform basic mathematical calculations, balance and reconcile figures, and transcribe accurately
High school diploma or GED required
Minimum one year related healthcare experience preferred, such as professional medical/billing, insurance follow-up, or accounts receivable follow-up. Relevant education may substitute experience requirement. Prior experience reading and interpreting Explanation of Benefits (EOB) preferred
Physical Demands / Working Conditions– Requires prolonged sitting/standing, some bending, stooping, walking and stretching. Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other officeequipment. Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports or other information. Requires lifting papers/boxes and pushing/pulling up to 25 pounds occasionally. Work is performed in an office environment or hospital setting. Work may be stressful at times. Contact may involve dealing with angry or upset people. Staff must remain flexible and available to provide staffing assistance for any/all disaster or emergency situations.
OSHA Category– The normal work routine involves no exposure to blood, body fluids, or tissues (although situations can be imagined or hypothesized under which anyone, anywhere, might encounter potential exposure to body fluids). Persons who perform these duties are not called upon as part of their employment to perform or assist in emergency care or first aid, or to be potentially exposed in some other way.