Revenue Cycle EDI & Enrollment Specialist

IES is dedicated to cultivating best practices in emergency care providing comprehensive acute care services creating value and supporting patients employees clients providers and physicians in pursuit of the highest quality health care.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Will be responsible for managing the payor linking process including the development of linking strategies for account processing and establishing procedures for access management.
• Will be responsible for setting up new group forms with RCM vendors for EDI.
• Will manage and set-up new group administrator access across all payor websites and manage client profiles across all platforms and all websites for all groups.
• Will evaluate direct vendors and personally facilitateEFT and ERA enrollment for all groups and all payors.
• Will manage website access for IES and its vendors.
• Will manage all profile attestations for payor linking.
• Will manage reporting and processes to redirect paper mail to lockbox and/or convert to ERA and EFT/ACH.
• Manages the processes associated with new and change payer set ups as it relates to 270/271 eligibility 835/837files and EFTs.
• Responsible for updating workflow processes and documentation related to payor linking (EDI EFT and/or ERA).
• Manage bank account and address linking for all groups.
• Collaborates with vendor(s) and serves as the primary contact for payor linking.
• Research and compile new payor contract and/or enrollment scoping for all groups and all payors.
• Source primary contact and/or process for payor contracting and present to leadership.
• Assist with research through payor websites as applies to new or existing payor contracts.

QUALIFICATIONS

Knowledge Skills Abilities: To perform this job successfully an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Strong working knowledge of healthcare EDI standards (HIPAA X12 HL7) and payer enrollment processes including ERA and EFT/ACH
• Proficiency navigating payer portals clearinghouse platforms and vendor systems used for EDI enrollment and claims data exchange
• Advanced analytical and problemsolving skills to evaluate payer requirements resolve enrollment barriers and interpret EDIrelated data
• Ability to exercise discretion and independent judgment when developing linking strategies managing vendor relationships and resolving complex payer issues
• Strong organizational skills with the ability to manage multistep processes competing priorities and timesensitive deliverables
• Excellent written and verbal communication skills for coordinating with payers vendors clients and internal teams
• High proficiency with MS Office applications and comfort working across multiple systems and administrative platforms
• Ability to identify workflow gaps recommend process improvements and maintain accurate documentation and auditready records
• Ability to handle sensitive financial provider and PHI information with confidentiality and professionalism
• Ability to work independently and collaboratively in a fastpaced detailoriented environment

Education / Experience: Include minimum education technical training and/or experience preferred to perform the job.

Required:

• HS Diploma or GED equivalent
• 3 years of experience working in EDI and Healthcare Revenue Management or Revenue Cycle Management with a focus on healthcare remittance processing and enrollments
• 3 years of experience with EDI enrollment and/or insurance portal management
• 3 years of experience with billing collections and/or coding in revenue cycle
• Working knowledge with various payer systems and basic enrollment processes (ERA vs. ACH/EFT)
• Working knowledge of healthcare specific EDI standards (HIPAA X12 HL7) and transactions sets (270s 271s 837s 835s etc)
• Extensive knowledge of medical terminology and revenue cycle industry

Preferred:

• Bachelors Degree in Healthcare Management Business Project Management or a related field

PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Specific vision requirements include the ability to see at close range distance vision peripheral vision depth perception and the ability to adjust focus
• While performing the duties of this job the employee is regularly required to talk and hear
• Frequently required to stand walk sit use hands to feel and reach with hands and arms.
• Possess the ability to fulfill any office activities normally expected in an office setting to include but not limited to: remaining seated for periods of time to perform computer based work participating in filing activity lifting and carrying office supplies (paper reams mail etc.)
• Occasionally lift and/or move up to 20-25 pounds
• Fine hand manipulation (keyboarding)

WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Office environment;Hybrid schedule
  • 4835 Lyndon B Johnson Fwy Dallas TX 75244
  • Monday/Friday remote
  • Tuesday-Thursday in office 8am-5pm
• May visit hospital locations and vendors
• The noise level in the work environment is usually low

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

The company is committed to creating a diverse inclusive and equitable environment and is proud to be an equal opportunity employer. Qualified applicants of any age race religion nationality sexual orientation gender identity or expression disability or veteran status will receive equal consideration for positions. We welcome people of diverse backgrounds experiences and abilities and believe that the unique experiences of our team drive our success.