EDI Specialist

Catholic Health is one of Long Island’s finest health and human services agencies. Our health system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island.

At Catholic Health, our primary focus is the way we treat and serve our communities. We work collaboratively to provide compassionate care and utilize evidence based practice to improve outcomes – to every patient, every time.

We are committed to caring for Long Island. Be a part of our team of healthcare heroes and discover why Catholic Health was named Long Island's Top Workplace!

This position is accountable for providing timely and accurate claim submission to achieve cash optimization and accounts receivable reduction to meet CH financial goals.  This is a hybrid role requiring both in office and remote work.

Duties and Responsibilities:

• Using MS Excel, ADS reports, EPIC reports, and OnBase, accountable for daily claim file download and reconciliation between the physician electronic billing systems.  
• Accountable for the daily transmission of electronic billing systems claims for direct and clearing house submissions. 
• Reconciliation of claims billed, held, and in error
• Electronic receipt of transmitted claims
• Resolution of claims payers would not accept
• Accountable for ensuring maintenance of billing system and logs.  Including un-transmitted log, open ticket log, department claim issues, and reconciliation reports.
• Accountable for daily ERA receive and install jobs through electronic billing system, as well as CH jobs to process the files. 
• Accountable for resolution of claims edits, communicating and collaborating with internal and external resources as needed for completion.
• Accountable to test new software releases with documented test plan.
• Work directly with the IT team to test and resolve issues with ADS, EPIC and the clearinghouse.
• Knowledge of Medicare, Medicaid and third party regulations to ensure proper billing and accuracy of system edits.  
• Assist with analysis process for modifying and or upgrading existing system controls and master files.
• Complete all requests for updates to master files as needed.
• Provide proof of timely filing on claims to aid in filing appeals.
• Recommends to management process improvements that will enhance productivity and quality.
• Accountable for trending increases in payor rejections and researching directly with the carrier via calls and/or the portal. 
• Performs related duties as assigned and unrelated duties as requested.
• Contributes to and consistently applies Catholic Health policies, procedures, and benefits to all customers and/or employees without discrimination.
• Employee conducts himself/herself in conformity with the HIPAA Compliance Program and applicable institutional policies and procedures for patient privacy.  In addition, employee conducts himself/herself in conformity with the Catholic Health Security policies and procedures.

Education:

High school diploma or equivalent

Skills:

• Able to make effective, timely decisions based upon sound judgment, data and experience, considering implications and consequences.  Must be highly analytical and have strong problem solving skills.
• Works in an organized manner, uses time effectively.  Monitors systems and assist in developing structures that prove helpful in meeting performance objectives. 
• Excellent computer skills required.  Must be proficient in electronic billing system and HIS system.  Proficient in MS Excel preferred. 
• Excellent interpersonal communication skills are required for interacting with internal staff, customers and representatives from external departments and agencies.

Experience:

• Knowledge of CPT/HCPCS and ICD-9 preferred. 
• Knowledge of Medicare, Medicaid and third party billing regulations required.
• Two years billing experience and working knowledge of coding required.
• Knowledge of 837 billing file structure and requirements required.

This range serves as a good faith estimate and actual pay will encompass a number of factors, including a candidate’s qualifications, skills, competencies and experience. The salary range or rate listed does not include any bonuses/incentive, or other forms of compensation that may be applicable to this job and it does not include the value of benefits.

At Catholic Health, we believe in a people-first approach. In addition to the estimated base pay provided, Catholic Health offers generous benefits packages, generous tuition assistance, a defined benefit pension plan, and a culture that supports professional and educational growth.

Salary : $26 - $33