Electronic Data Interchange Specialist

Summary

The Electronic Data Interchange Specialist will be responsible for assuring all claims that are processed through Electronic Medical Records and Practice Management Software are correctly billed and compliant. Validation through claim edit software before processing to the clearinghouse is essential. The Electronic Data Interchange Specialist will conduct random audits for proper coding of CPT codes vs. diagnosis codes and therefore must stay current with all insurance policy, CPT, HCPCS, and ICD-10-CM code changes throughout the year.

• Ensure all claims processed through OncoEMR and Centricity are correct and compliant.
• Ensure proper documentation is on file.
• Validate all Billing through claim scrubbers before processing to the clearinghouse.
• Conduct random audits for proper coding of CPT codes vs diagnosis codes.

Education

• To stay current with all CPT and ICD-10 early updates, as well as drug policies per insurance carriers

Certifications & Licenses

• High School diploma or GED

Experience

• ICD-10 & CPT Coding experience in a medical office preferred
• Able to navigate a billing system and understand how to read complex coding situations
• Analytical and excellent computer skills as well as attention to detail are a must

Education/Certifications & Licenses

• High School diploma or GED

Core Competencies, Knowledge/Skills/Abilities

• Analysis & Critical Thinking
• Strong interpersonal skills to include effective verbal and written communication
• Solid time management with the ability to prioritize multiple tasks
• Ability to collaborate across various levels of management, departments, and teams
• Comfortable negotiating problems and exploring solutions with physician population

Values

• Patient First – Keeping the patient at the center of everything we do
• Accountability – Taking responsibility for our actions
• Commitment & Care – Upholding FCS vision through every action
• Team – Working together, one team, one mission