BioScrip, Inc. EDI Support Specialist in Aurora, Colorado

EDI Support Specialist

Location: Aurora, CO

Job Id: 5015

of Openings: 1

BioScrip, Inc. is the largest independent national provider of infusion and home care management solutions, with approximately 2,100 teammates and nearly 70 service locations across the U.S. BioScrip partners with physicians, hospital systems, payors, pharmaceutical manufacturers and skilled nursing facilities to provide patients access to post-acute care services. BioScrip operates with a commitment to bring customer-focused pharmacy and related healthcare infusion therapy services into the home or alternate-site setting. By collaborating with the full spectrum of healthcare professionals and the patient, BioScrip provides cost-effective care that is driven by clinical excellence, customer service, and values that promote positive outcomes and an enhanced quality of life for those it serves. Ours is a fast-paced dynamic work environment with room for new ideas and opportunities for career advancement. We offer a wide array of welfare benefits as well as Tuition Reimbursement, an Employee Referral Program, and a 401(k) Retirement Savings.

Job Title: EDI Support Specialist

SUMMARY

Focuses efforts on excellent customer service related to the use of Zirmed for eligibility, claims and reporting. Provides technical support for new payor mappings. Responsible for enrollment of payors for ERA to maximize ERA posting in CPR+. Provides ongoing feedback to Reimbursement regarding errors and reports trends. Performs insurance payor audits between CPR+ and Zirmed to ensure accurate claim submission information. Works with Process Improvement Team as part of training initiatives.

ESSENTIAL FUNCTIONS

To perform this job successfully, an individual must be able to perform each essential function satisfactorily, with or without reasonable accommodation.

  • Monitors and communicates progress on the assigned tasks related to ERA Enrollment process.

  • Responds to inquiries regarding EDI issues with enrollment, claims, payments, and/or clearinghouse activities

  • Manage enrollment notices (approvals and/or rejections) from payers.

  • Contact payers for enrollment follow up or status as necessary

  • Track enrollment process to assure provider enrollment is completed with all appropriate payers

  • Conducts analysis of EDI transactions and is responsible for documentation and reports

  • Ability to multi-task and manage concurrent assignments with proper follow-ups

  • Respect and maintain HIPAA confidentiality guidelines.

  • Maintains the highest level of confidentiality and integrity when dealing with company’s intellectual property.

  • Performs other duties as needed

EDUCATION, TRAINING AND EXPERIENCE REQUIREMENTS

HS Diploma or GED required. Bachelor's degree preferred. A minimum of three years’ experience in healthcare billing with a focus on EDI is required. Experience with Zirmed is preferred. Proficiency in Microsoft Excel is required. Experience with Encounter Digital Implementation via EDI translation tool is required. Experience with network connectivity operations and/or medical claim processing is desired.

KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED

The requirements listed below are representative of the knowledge, skill, and/or ability required, with or without reasonable accommodation.

  • Hands on knowledge on healthcare related EDI transactions (e.g. 837, 834, 270, 271, and 835).

  • Excellent technical and analytical skills, including proficiency with Excel

  • Knowledge of HIPAA confidentiality guidelines.

  • Maintains the highest level of confidentiality and integrity when dealing with company's intellectual property.

  • Ability to work independently under direction of local management.

  • Ability to interact appropriately with all levels of management and staff within current organizations and newly acquired companies.

  • Excellent verbal and written communication skills.

  • Significant system knowledge of CPR+ (all versions) preferred.

  • Knowledge of electronic billing.

  • Ability to understand insurance contracts for billing purposes.

  • Ability to prioritize and handle multiple tasks and projects concurrently.

  • Demonstrated knowledge and proficiency in the principles, procedures and best practices related to this position.

  • Strong attention to detail.

  • Proficient in MS Office.

Language Skills

Ability to read, analyze and interpret information appropriate to duties and responsibilities assigned. Ability to operate information systems, follow policy, complete required forms, and prepare reports. Ability to effectively present information and respond to questions from patients, and payors.

Mathematical Skills

Ability to perform basic mathematical calculations.

Reasoning Ability

Ability to define problems, collect data, establish facts, and draw valid conclusions.

BioScrip is an equal opportunity employer. All employment decisions are made without regard to age, color, race, ancestry, national origin, disability, genetic information, military status, religion, creed, sex, pregnancy, childbirth, marital status, citizenship, sexual orientation, gender identity, gender expression, legally protected medical condition, or any other basis prohibited by applicable law. Background checks and drug screens are part of our hiring process. Affirmative Action/Equal Opportunity Employer, Minority/Female/Disabled/Veteran.