Job Title: Electronic Data Interchange (EDI) Claims Filing Specialist
Location: Onsite, Brentwood, TN
Shift: Monday to Friday, 7:00 AM - 4:00 PM
Job Type: Full-Time
Work Type: Contract with possibility of extension
Job Summary:
We are seeking an organized and detail-oriented Electronic Data Interchange (EDI) Claims Filing Specialist to join our team located in Brentwood, TN. This role is responsible for accurately preparing, submitting, and reconciling claims to ensure efficient, timely, and compliant processing with payors. The ideal candidate will have strong analytical skills, a customer-oriented mindset, and proficiency with PC software, particularly Microsoft Office. Reporting to the EDI Manager, this position does not have supervisory responsibilities but will require effective teamwork and the ability to work independently.
Desired Traits and Qualifications:
Basic Skills: Strong organizational skills, ability to manage multiple tasks under time constraints, and comfort working in a fast-paced environment. Adaptability, problem-solving skills, and attention to detail are essential.
PC Proficiency: Competency with Microsoft Office applications and other required software.
Customer Orientation: Skilled in building and maintaining positive, long-term relationships with customers by consistently meeting expectations.
Interpersonal Skills: Ability to work effectively with colleagues, patients, and external parties.
Education and Experience:
High school diploma or GED preferred.
Minimum one year of healthcare experience in medical claims billing (both paper and electronic) preferred; relevant education may substitute experience requirements.
Key Responsibilities:
Claims Processing: Review and prepare claims for submission to payors, both electronically and via paper, following departmental policies and procedures.
Error Resolution: Correct billing and clearinghouse errors, ensuring claims are submitted accurately and promptly.
Documentation Management: Collect and verify additional documentation as needed to meet payor requirements.
Daily Reconciliations: Work through daily reconciliations to ensure all claims are tracked and accounted for across billing, work queue, and clearinghouse systems.
Correspondence Review: Address incoming correspondence to resolve claim issues, updating methods as needed.
Performance Metrics: Consistently meet departmental metrics for production and quality standards.
Maintain Knowledge Base: Stay updated on departmental workflows, systems, and tools.
Compliance: Adhere to the organization's Code of Conduct, Mission, and Value Statements.
Physical Requirements:
Ability to sit or stand for extended periods, with occasional bending, stooping, walking, and stretching.
Manual dexterity to operate office equipment such as keyboards, photocopiers, and telephones.
Occasional lifting and pushing/pulling of up to 25 pounds.
Work may be performed in an office or hospital setting and may involve stressful situations.