Revenue Cycle Collections Coordinator

Mission

Maintain and enhance the EDI infrastructure to ensure smooth transmission of data between the health plan and healthcare providers.

Responsibilities

• Monitor and assist in the management of all the EDI systems for claims submissions, lockbox set up, ERA/EFT enrollments.
• Resolve any EDI-related issues, including rejected or denied claims, formatting errors, data discrepancies, set up issues, and/or access issues.
• Collaborate with IT teams and vendors to maintain and enhance the EDI infrastructure and resolve technical issues.
• Build and maintain strong working relationships with healthcare providers, EDI clearinghouses, insurance carriers, and other external partners.
• Collaborate with internal teams, including claims operations, customer service, and IT, to address provider inquiries, resolve EDI-related issues, and improve overall claims processing efficiency.

Requirements

• Stay up to date with industry standards, regulatory requirements, and best practices related to EDI in healthcare administration or health plan industry.
• Ensure adherence to HIPAA regulations and other privacy and security guidelines while handling sensitive claims data.
• Identify opportunities to streamline and optimize the claims EDI process, leveraging technology, automation, and industry best practices.
• Complete state reporting as necessary. Process and complete THCIC file submissions as necessary for all facilities.

Qualifications

• Bachelor’s degree in healthcare administration, business, information technology, or a related field (or equivalent experience).
• Strong experience with databases and software systems, EDI standards and protocols, payment posting and other relevant healthcare industry standards.
• Experience with coding systems, such as CPT, ICD-10, and HCPCS, and other applications regarding claims processing.
• Experience in troubleshooting and resolving EDI-related issues, including rejected or denied claims, formatting errors, and data discrepancies.
• Experience in generating reports, analyzing data, and using performance metrics to drive process improvement initiatives.
• Familiarity with project management principles and the ability to lead or contribute to process improvement projects.
• Proficient in using healthcare information systems and patient access software.
• Experience in process improvement and implementing best practices.