Job Description

Integrative Emergency Services, LLC (“IES”) is seeking a Revenue Cycle EDI Enrollment Specialist (ESS) who will be responsible for facilitating and managing provider enrollment for all new and existing clients. The EES is responsible for completing and/or overseeing vendor management for all EFT/ERA enrollment submissions for the appropriate payors, providing payor portal access to the appropriate entities, and updating remittance and demographic information for all entities. This specialist will develop, coordinate, implement, and manage all payer/EDI-related processes. Additionally, the EES serves as the primary link between IES and any claims/payer data-trading partners and vendors and manages those relationships. The EES’ job is to ensure all items are accurately obtained, tracked, setup, updated and communicated for each implementation and/or payer/provider change.

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 oversee EFT 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, 837/835 files and EFT’s.
• 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.

• Excellent analytical, organizational, and verbal/written communication skills
• Detail orientation
• Ability to manage multiple priorities
• Strong customer service orientation
• Ability to use discretion appropriately and maintain confidentiality
• High levels of proficiency with MS Office applications
• Ability to function in a hands-on environment
• Ability to read, write and speak English proficiently

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

TRAVEL

• Occasional travel may be required

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.

Job Tags

Similar Jobs