Analyst I, EDI Services (Remote)

Overview

The (Remote) RCM Analyst I, EDI Responsible for analyzing, researching and resolving issues related to the creation and submission of paper and electronic claims. Works with the Business Systems Department to create effective clearinghouse edits which respond to errors generated from electronic claims submissions. Monitors claim errors until resolved. Identifies opportunities for new edits based on billing analysis.

Responsibilities

Retrieves, researches and resolves all front-end rejections from clearinghouse vendor. Investigates and resolves carrier edits / error within the billing system. Makes necessary corrections and re-bills the claim timely.

Within established Standard Operating Procedures, clearly and completely document all information relevant to claim error reviews and corrections in the patient accounting system consistent with permanent legal records.

Interacts and communicates with Provider Enrollment to resolve outstanding issues. Coordinates with the PE Department to ensure re-bills are sent for providers following enrollment completion.

Notifies the Collections Management Team of any unusual or large volume payer trends / denials.

Works with updating insurance information for claims that need to be re-billed.

Preforms other job-related duties within the job scope as requested by Management. 

Qualifications

High school diploma or general education degree (GED); or equivalent combination of education and experience.

Preferred: Healthcare or Revenue Cycle Management experience.

Basic Microsoft Office experience.

Ability to communicate both verbally and written.

Ability to effectively present information and respond to questions from customers and vendors.

Ability to read, analyze, and interpret general business documents, technical procedures and governmental regulations. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Ability to define problems, collect data, establish facts, and draw valid conclusions.

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.

Ability to calculate figures and amounts such as discounts and percentages.

Benefits and Compensation

Benefits for Full Time employee and qualified dependents:

• Health Insurance including prescription drugs
• Dental Insurance
• Vision Insurance
• Life Insurance
• Short- and Long-Term disability options
• Employee stock purchase program – 15% discount*
• 401k with company match**
• Long Term Care (LTC)
• Pre-tax Health Savings Account (HSA)
• Pre-tax Flexible Spending Accounts (FSA)
• Aflac Hospital, Critical Illness and Accident plans
• Identity Protection
• Employee Assistance Program (EAP)

*Part Time Regular employee classifications also receive this benefit.

** Available to part-time regular and part-time casual employees age 21 and over.

About Us

Pediatrix® Medical Group, Inc. (Pediatrix) is the nation’s leading provider of physician services. Pediatrix-affiliated clinicians are committed to providing coordinated, compassionate and clinically excellent services to women, babies and children across the continuum of care, both in hospital settings and office-based practices. Specialties include obstetrics, maternal-fetal medicine and neonatology complemented by more than 20 pediatric subspecialties, as well as pediatric primary and urgent care clinics. The group’s high-quality, evidence-based care is bolstered by significant investments in research, education, quality-improvement and safety initiatives. The physician-led company was founded in 1979 as a single neonatology practice and today provides its highly specialized and often critical care services through more than 5,000 affiliated physicians and other clinicians in 37 states. 

Please Note: Fraudulent job postings/job scams are becoming increasingly common. All genuine Pediatrix job postings can be found through the Pediatrix Careers site: www.pediatrix.com/careers.

Pediatrix is an Equal Opportunity Employer

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.