Revenue Cycle Collections Coordinator

ACH EMPLOYMENT SERVICES LLC Houston, TX $24.00 to $30.00 per hour

Position Summary:

The Revenue Cycle EDI Coordinator is responsible for managing and maintenance of all electronic data interchange (EDI) processes for claims submissions; ERA and EFT enrollments; web portals for insurance carriers, claim submission clearinhouse9(s), assisting in the implementation of new facility starts and/or maintaining and updating all facility information for all EDI functions. This position requires strong technical skills, attention to detail, and knowledge of healthcare industry standards. The Claims EDI Coordinator works closely with internal teams, external partners, and healthcare providers to facilitate seamless claims processing and resolve any issues related to EDI transactions. The EDI Coordinator will be responsible for oversight and completion of all THCIC reporting and file submission on the monthly, quarterly and annual basis.

Essential Duties and Responsibilities:

· Monitor and assist in the management of all the EDI systems for claims submissions, lockbox set up, ERA/EFT enrollments to ensure smooth transmission of data between the health plan and healthcare providers.

· Assist to resolve any EDI-related issues, including rejected or denied claims, formatting errors, data discrepancies, set up issues, and/or access issues.

· Collaborate with IT teams and vendors to maintain and enhance the EDI infrastructure and resolve technical issues.

· Build and maintain strong working relationships with healthcare providers, EDI clearinghouses, insurance carriers, and other external partners to facilitate effective claims processing and issue resolution.

· Collaborate with internal teams, including claims operations, customer service, and IT, to address provider inquiries, resolve EDI-related issues, and improve overall claims processing efficiency.

· Stay up to date with industry standards, regulatory requirements, and best practices related to EDI in healthcare administration or health plan industry.

· Ensure adherence to HIPAA regulations and other privacy and security guidelines while handling sensitive claims data.

· Identify opportunities to streamline and optimize the claims EDI process, leveraging technology, automation, and industry best practices.

· Complete state reporting as necessary. Process and complete THCIC file submissions as necessary for all facilities.

Education and Experience:

• Bachelor’s degree in healthcare administration, business, information technology, or a related field (or equivalent experience).

• Strong experience with databases and software systems, EDI standards and protocols, payment posting and other relevant healthcare industry standards.

• Experience with coding systems, such as CPT, ICD-10, and HCPCS, and other applications regarding claims processing.

• Experience in troubleshooting and resolving EDI-related issues, including rejected or denied claims, formatting errors, and data discrepancies.

• Experience in generating reports, analyzing data, and using performance metrics to drive process improvement initiatives.

• Familiarity with project management principles and the ability to lead or contribute to process improvement projects.

• Proficient in using healthcare information systems and patient access software.

• Experience in process improvement and implementing best practices.

Physical Demands:

The physical demands for this position include: adequate vision, hearing, and repetitive motion. Light physical activity performing non-strenuous daily activities of an administrative nature. Ascending or descending stairs, ramps, and the like, using feet and legs and/or hands and arms. Substantial movements (motions) of the wrist, hands and/or fingers in a repetitive manner. Bending legs downward and forward by bending leg and spine.

Work Environment:

Well-lighted, heated and/or air-conditioned indoor office setting with adequate ventilation.

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