EDI Analyst

Company Intro

At American Vision Partners (AVP), we partner with the most respected ophthalmology practices in the country and integrate best-in-class management systems, operational infrastructure, and advanced technology to provide the highest quality patient care possible. Our practices include Barnet Dulaney Perkins Eye Center, Southwestern Eye Center, Retinal Consultants of Arizona, M&M Eye Institute, Abrams Eye Institute, Southwest Eye Institute, Aiello Eye Institute, Moretsky Cassidy Vision Correction, Wellish Vision Institute, West Texas Eye Associates and Vantage Eye Center. We are focused on building the nation’s largest and most comprehensive eye care practices and currently operate more than 100 eye care centers in Arizona, New Mexico, Nevada, California and Texas – including 25 ambulatory surgical centers.At AVP we value teamwork, providing exceptional experiences, continuous improvement, financial strength, and hard work. We are committed to providing best-in-class patient care, pioneering research and technology, and most importantly, rewarding and recognizing our employees!

Overview

*This role is seeking candidates who specialize in EDI analytics and ERA/EFT Enrollments, we are not seeking developers and/or designers, thank you!*

 

As an EDI Analyst, you will be responsible for the development, implementation and ongoing maintenance of the Electronic Data Interchange (EDI) transactions including HIPAA 270/271 eligibility inquiry and response, 276/277 claims status inquiry and response, and 278 referral/prior authorization transactions. The EDI Specialist works with claims and payment teams on the HIPAA 837 -Health Care Claim and 835-Health Care Claim Payment/Advice. The EDI Specialist will work collaboratively with information systems staff, government and third-party payers, clearinghouses, and Nextgen technical support personnel to implement these transactions in an integrated, efficient, and cost-effective manner. This position will have responsibility for planning, implementing and managing HIPPA EDI projects relating to these transactions, including end-user contact, analysis, design, mapping, programming, training and documentation. Ideal candidates will require a certain level of revenue cycle management experience in order to successfully fulfill the job responsibilities.

Responsibilities

• Setup and Complete EDI registration for all EDI products, including facilitating payer-specific enrollments, until payer grant approval.
• Install and Configure healthcare electronic data interchange applications on provider’s network and/or billing stations.
• Research and analyze providers’ billing requirements to ensure all data fields are mapped and converted correctly in X12 ANSI inbound/outbound file.
• Initiates test EDI transaction prior initial implementation live environment. Conduct post-live support for 6 to 8 weeks by monitoring and assessing the overall usage of EDI products, and conducting weekly follow-up calls with billing administrators to ensure accuracy
• Customize the provider inbound/outbound EDI transactions based on specific payer edits/requirements received in responses.
• Make recommendation on additional resources and feature that adds leverage to EDI product and provides efficient solutions to the practice business operations.
• Devise solutions and provide status to revenue cycle leadership throughout the EDI implementation process on a bi-weekly basis.
• Serve as liaison between provider and healthcare trading partners regarding EDI inquiries including rejections with enrollment, claims, payments, and/or clearinghouse interfacing.
• Setup new payer/ connection setup, testing, and launch. Research and analyze new payer requests and submit to EDI QA/Development team to program accordingly.
• Maintains and update remit address changes with government and commercial payers weekly, monthly or quarterly
• Manage payer website logins, grant new access, deactivate access and provide password resets for revenue cycle management teams.
• Formal testing methodology, test plan development and execution, and documentation of test results
• All other assigned duties. 

Qualifications

• REQUIRED:  Minimum five (5) years experience in Healthcare revenue cycle management (patient financial services/patient access). 

• A minimum of 2-3 years experience with hands-on involvement relative to ANSI X12 Healthcare EDI transaction sets (837, 999, 277CA, 276/277, 835)
• Experience with ERA/EFT enrollments from a hands-on analyst or role perspective.
• Prior EDI or System implementation and Transaction Mapping experience
• Experience in NextGen EHR system, or other healthcare EHR software.
• Proficient in Microsoft Office, specific but not limited to Excel (advanced formulas, pivot table use), PowerPoint, Word, Outlook, and SmartSheet navigation.
• High school diploma or GED required. BA/BS in Information Technology, Computer Science, Computer Engineering, equivalent is preferred.
• Previous experience in clearinghouse platform use and navigation, e.g. Waystar, Change Healthcare.

 

Benefits & Perks

Your health, happiness and your future matters! At AVP, we offer everything from medical and dental insurance, significant eye care discounts, child care assistance, pet insurance, continuing education funds, 401(k), paid holidays, PTO, Sick Time, opportunity for growth, and much more!