Electronic Data Interchange Claims Filing Specialist

Electronic Data Interchange (EDI) Claims Filing Specialist

Location:
Brentwood, TN 37027

Shift:
8 hours-flexible between 6 am-6 pm, Monday through Friday

Job Summary:
The EDI Claims Filing Specialist is responsible for ensuring that claims are accurately submitted to payors, either electronically or via paper, with all required documentation. The role requires detailed compliance with departmental policies and a proactive approach to problem-solving in a fast-paced environment.

Reports to:
EDI Manager

Key Responsibilities:

• Prepare claims for submission to payors, ensuring adherence to departmental policies.
• Correct billing and clearinghouse errors to ensure successful claim submissions.
• Research payor filing requirements and provide additional information as needed to resolve filing issues.
• Perform daily reconciliations to account for all claims across the billing system, work queue system, and clearinghouse.
• Process correspondence to resolve any claims-related inquiries.
• Meet departmental performance metrics for production and quality.
• Maintain proficiency with departmental workflows, systems, and tools.
• Adhere to the organization's "Code of Conduct philosophy and "Mission and Value Statement.
• Perform additional duties as assigned.

Desired Skills and Traits:

1. Basic Skills:

   • Strong organizational and multitasking abilities to handle multiple demands in a fast-paced setting.
   • Ability to work independently and as part of a team.
   • Adaptability, analytical skills, problem-solving ability, and attention to detail.
   • Proficiency in basic math, balancing and reconciling figures, and accurate transcription.

2. PC Skills:

   • Proficiency in Microsoft Office applications and other required software.

3. Customer Orientation:

   • Establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations.

4. Communication Skills:

   • Ability to communicate clearly and concisely, both verbally and in writing, with proper punctuation and grammar.

5. Interpersonal Skills:

   • Able to work effectively with colleagues, patients, and external parties to build positive relationships.

6. Policies & Procedures:

   • Familiarity with organizational policies, procedures, and systems.

Qualifications:

• High school diploma or GED preferred.
• Minimum of one year of experience in healthcare-related medical claims billing (both paper and electronic) is preferred. Relevant education may substitute for experience.

Physical Demands and Working Conditions:

• Prolonged sitting/standing, occasional bending, stooping, walking, and stretching.
• Requires manual dexterity and eye-hand coordination for operating office equipment.
• Ability to lift and push/pull up to 25 pounds occasionally.
• Work is primarily in an office environment and may be stressful at times. Staff must be flexible and available to provide assistance in emergency situations.

Nesco Resource offers a comprehensive benefits package for our associates, which includes a MEC (Minimum Essential Coverage) plan that encompasses Medical, Vision, Dental, 401K, and EAP (Employee Assistance Program) services.