Signature Healthcare is Southeastern Massachusetts’ premier local provider of quality, personalized medical services. We are comprised of the award-winning not-for-profit Signature Healthcare Brockton Hospital; Signature Medical Group (SMG), a multi-specialty physician group of more than 150 physicians practicing in 18 ambulatory locations. We believe our distinctive Signature Healthcare team approach is the way healthcare should be: medical professionals across many locations communicating and collaborating, taking advantage of technologies and resources to make a difference in the lives and health of our patients.

Position Summary:

Under the general supervision of the Manager, B/AR IT Systems, the Revenue Cycle EDI Specialist conducts EDI (Electronic Data processing/interchange) functions, including: electronic claims processing; remittance processing; outside agency data transfers; and documentation of EDI processes. In addition, the EDI specialist will work with PFS scripting programs and perform other revenue systems tasks as necessary, including preparation of reports for both internal and external agency use. Functions independently within established department policies and goals. Refers specific problems to supervisor for clarification of operating policies and procedures.

 

Location: West Center St, West Bridgewater, MA

Department: Revenue Integrity

This is a full-time 40 hour/ week position

 

Responsibilities:

Creates daily MEDITECH 837 claim files and delivers them to all designated payors in a timely fashion, including insurance companies, clearinghouses, and claim scrubber vendors. Maintains logs, records and other monitoring tools to insure that all imported and exported files are accounted for and effectively transmitted or processed. Distributes Claim file totals reports and claim check rejection reports to Patient Accounting staff. Communicates the status of file transmissions; claim file totals; remittance advice totals; and distributes error reports to Patient Accounts staff. Downloads and processes ANSI 997 acknowledgements. Downloads and processes 835 remittance advices. Downloads and processes 270 claim status transaction files when generated. Monitors successful file transmission and retrieval, using payor website tools, Nehen, and other tools. Processes all rejection reports associated with daily remittance files and corrects rejected transactions. Oversees file transmissions and processes all comment files from and to outsourced statement/collection agencies. Communicates effectively with PFS staff in order to effectively transfer all electronic files. Communicates with Cashiers to reconcile electronic cash postings with cash receipts. Downloads data and prepares reports for both internal and external distribution. Participates actively in the process of redesigning more efficient EDI processes for PFS. Utilizes scripting tools to read data into the MEDITECH system. Attends meetings as necessary. Performs other duties as required or assigned.

 

BASIC KNOWLEDGE/SKILLS/APTITUDE/EXPERIENCE:

Ability to solve practical problems and deal with a variety of variables in situations where only limited standardization may exist. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. Must be able to reasonably make appropriate judgment in communications and actions with patients, physicians, other associates, outside agencies, and vendors. Must have the ability to follow and document standard EDI procedures. Must have the ability to create, transmit, and process claims and remittance files from the MEDITECH B/AR system. Must have the ability to use file transmission tools such as: MMIS, Doo Dad, NEHEN, FTP, Emdeon, and other transmission protocols.  Must have the ability to understand and troubleshoot issues with MEDITECH FTP transmissions and spooling. Must have ability to import, download, decrypt, troubleshoot and manage the various files used by payors, vendors and other users with which the Revenue Cycle Dept. interacts and/or does business.  Must be able to download PFS data and manipulate it using Microsoft Office and other tools such as Excel, Access, Monarch, etc. Must have effective verbal and written communication skills.

 

Education/Experience/Licenses/Technical/Other:

Education:  High school diploma or equivalent required. Experience: Certification/Licensure:  N/A Software/Hardware: Other: