Job purpose

 

The EDI Specialist is responsible for facilitating all activities between the provider, clearinghouse and IT in order to establish connectivity for submitting claim files.  They will work closely with Network Management, Contracting and Claims to ensure all appropriate data elements are transmitted for claims payment.  They will also be responsible for creation and maintenance of associated companion guides and mapping business rules as well as monitoring throughput on all submitters and converting paper submitters to EDI

 

Duties and responsibilities

·         Act as a liaison between the provider and IT to set-up providers submitting new claim files

·         Coordinate set-up activities with selected clearinghouse to ensure proper steps are followed for an effective transition

·         Validate post-implementation submissions to ensure file integrity and established business rules are applied

·         Perform an outreach process to determine proper EDI submission method and customize based upon provider’s business needs

·         Identify providers who submit paper claims to target for EDI implementation

·         Publish monthly reports to illustrate EDI submission rates and related metrics

·         Investigate identified claims in-load discrepancies and work with related billers or vendors to remediate issue

·         Analyzing EDI 835 errors, coding, testing, debugging, documentation, modification and installation of all EDI processes

·         Initiates, communicates and coordinates all EDI activities with trading partners

·         Maintain documentation on procedures and processes

·         Ensure compliance with HIPAA policies and procedures

·         Ability to identify 835 program error resolution

·         Designing, writing and testing new software programs in our company framework (.NET). These applications are primarily ‘rich’ client applications but may also be Web applications

 

 Preferred Qualifications

·         Excellent interpersonal skills at both an individual and team level

·         Excellent written and verbal communication skills

·         Minimum 5-7 years of recent SQL server 2005/2008/2012 development including complex triggers and views

·         2+ years of SQL reporting experience is preferred

نوکری کی تفصیلات

کل عہدے:
2 آسامیاں
نوکری کی شفٹ:
گردشی
نوکری کی قسم:
نوکری کا مقام:
جنس:
کوئی ترجیح نہیں
کم از کم تعلیم:
بیچلرز
کیریئر کی سطح:
سربراہ شعبہ
کم از کم تجربہ:
5 سال (HealthCare, EDI Transactions)
اس سے پہلے درخواست دیجیۓ:
مئی ۲٦, ۲۰۱۷
تاریخِ اِشاعت:
اپریل ۲۷, ۲۰۱۷

ALTUMED

انفارمیشن ٹیکنالوجی · 51-100 ملازمین - ایبٹ آباد

Cube Healthcare Systems is a subsidiary of the US Based Healthcare IT Company; ALTUMED, providing healthcare solutions to the clients based in the US. Presently, CHS is the biggest company at KPITB, with fast growing healthcare IT services and product base. Altumed team of talented and well-coordinated individuals knows that the client’s ease and betterment is their ultimate goal. They put in extraordinary skills and effort to save physicians and their practices valuable time so that physicians can instead spend on providing better care to their patients. Serving as a bridge between care provider and payer, CHS is always accurate and very reliant. We take pride in processing millions of health insurance claims for doctors' offices, hospitals, and other healthcare facilities yearly. We have recently stepped into the IT World with our product: ALTUMED, a Revenue Cycle Management Software which takes Medical Billing to another degree of automation and advancement. With an RCM application, we have streamlined the business side of our client’s medical practice, getting more money per patient, more quickly, with much less wasted effort than is required during conventional payment collection practices. The extremely talented IT team works hard every day to improve the user experience and process for the clients. AltuMed is ICD-10 compliant medical solution used across various medical specialties like Cardiology, Nephrology, Dermatology, Hospice, and Durable Medical Equipment. As a company, CHS believes in diversity and inclusion. Which is why we have teams of capable people working with us from different cities of the country working together towards success. Apart from that, CHS has its paid internship program running throughout the year to set a strong foundation, full of learning opportunities for the fresh graduates to kick-start their careers. We strongly believe in empowering our younger generation for a progressive Pakistan.

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