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Job Profile Title Revenue Cycle - EDI Specialist II

Job Summary

The Revenue Cycle - EDI Specialist II is responsible for the transmission of all professional medical claims for UMCP from GE Centricity to final acceptance by the Payer. Manages daily flow of out-going file transmissions and in-coming payer rejections. Monitors for new rejection trends and research to determine the root cause for quick resolution. Communicates with team members, clinic, CBO, UMC IT and GE IT staff as needed. Reports to: Job Specific Responsibilities Daily assignments may include but are not limited to:

· Process and submit insurance claims.

· Verify and update patient account information.

· Resolve discrepancies in patient account balances.

· Maintains and archives EOBs in Impower and Easyprint.

· Creates and deletes queues in Account Collection and Task Management module.

· Assigns staff to queues. Identify trends and inform supervisor.

· Identify, track and monitor billing issues. Prepare and present training materials from identified trends and/or issues to supervisor.

· Has a clear understanding of Revenue Cycle to ensure accounts are routed to the proper department/clinic.

· Research claims filed to incorrect paper and electronic formats.

· Review charges marked as SUPER in task management edit and reject queues weekly.

· Assist with EFT/ERA enrollment set up.

· New systems set up, testing and implementation.

· Responsible for reviewing and resolving rejects not assigned to billing specialist I.

· Utilizes Analyzer to extract information for GE Centricity database.

· Cross analyze data from GE Centricity to Accounting reports to confirm accuracy.

· Works cooperatively with UMC IT department.

· Monitors batch alerts from clearing house and provides Management with impact data and keeps them informed of issue resolution.

Education and Experience

· High school diploma or equivalent.

· Previous experience in revenue cycle management or related field preferred.

Required Licensures/Certifications/Registrations N/A Skills and Abilities

· Strong attention to detail.

· Effective communication skills for collaborating with internal teams.

· Knowledge of coding and billing practices.

Interaction with Other Departments and Other Relationships The person in this role will collaborate with clinic managers, RCM Director, CBO Supervisors and staff.

Physical Capabilities Position requires prolonged periods of sitting at a desk, talking on a phone, and working on a computer. Essential hearing and near vision acuity required. Should be able to lift up to 20 pounds, push, pull, and stooping required at times. Environmental/Working Conditions Work area is in an office environment, well lit, and subject to varying indoor temperatures.

UMC Health System provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment on the basis of race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

*Request for accommodations in the hire process should be directed to UMC Human Resources.​*