Responsible for assessing and documenting requirements, establishing new (billing/claims/statements) systems databases for new clients and manages related projects. The Systems Specialist monitors, audits, gives guidance and direction to offshore partner teams according to company operating policies and procedures. The Specialist troubleshoots processing, spooling of claims, diagnoses process or systems issues and makes adjustments to databases as necessary. The Specialist monitors rejections, is authorized to make exceptions, adjustments and recommend and write modifications to policies and procedures. The Specialist Team is responsible for ensuring that client databases are closed properly each month within the 48 hour window. In addition the specialist monitors and facilitates the routine generation of claims and patient statements and the workflow on and offshore. They schedule the close for each of the 400+ entity databases, conduct the monthly transfer and reconciliation of collection files with external collection agencies; they are responsible for the generation of reports for daily/weekly/monthly essential processes and maintain and process all company requests. They are the liaison troubleshooting all issues with e-commerce, GPMS, proprietary systems, statement vendors and company constituents.
ESSENTIAL DUTIES AND RESPONSIBILITIES
1. Create and manage business system databases for all new clients; responsible for integrity of QA efforts for “go live” on start-ups
2. Responsible to manage all updates and maintenance of databases for all clients and to act as liaison with all systems constituents, vendors and offshore partners
3. Monitor, identify, and resolve claim rejection issues with offshore vendors in timely manner.
4. Monitor end of month close and make all necessary corrections.
5. Answer questions from all staff members, including offshore and systems vendors
6. Prepare, review, and monitor spooling claims and patient statements on a daily basis
7. Manages and maintains billing claim formats and requirements for various states
8. Maintain Constants in the GPMS billing system
9. Manage client fee schedules including: adding, deleting, and updating as needed to GPMS billing and Edits+ coding systems
10. Maintain CPT’S/Fees/RVU's including: adding, deleting, and updating as needed to GPMS billing and Edits+ coding systems.
11. Manage and Maintain Security for all users in the GPMS billing system to ensure system integrity.
12. Work directly with billing software vendor to troubleshoot issue; creating and managing all work orders to ensure timely completion.
13. Work directly with billing software vendor for system updates/upgrades.
14. Work directly with Provider Enrollment for ERA requests.
15. Work directly with Client Services on client issues/requests.
16. Create Ad Hoc custom reporting from internal customers.
17. Compile and send collection files to various agencies at the end of the month; follow-up with agencies to ensure reconciliation and complete file transfer.
18. Create and maintain Policies and Procedure documents for the department.
19. Makes recommendations to help streamline existing process and create new processes.
20. Other duties as assigned, directed, or requested.
High School Diploma or GED
QUALIFICATIONS AND REQUIREMENTS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Minimum of three years medical billing experience and/or Medical Billing System Support.
• Knowledge of insurance carrier requirements for claims submission for all states.
• Ability to work independently and make timely decisions is a must.
• Ability to multi-task; excellent organizational and planning skills is required.
• Ability to effectively communicate both in writing and verbally, as well as to interact in a professional manner with colleagues, from a variety of backgrounds and organization levels, patients, public, and client’s staff members.
• Attention to detail and high level of accuracy is required.
• Ability to work in a fast paced environment and reprioritize often.
• Ability to be available after hours during close to ensure completion of monthly processes.
• Strong analytical and problem solving skills are required.
• Demonstrated PC skills, i.e. proficient with MS Office products including, but not limited to: Word, Excel, Power Point, and Outlook.
• Familiarity with the Internet; ability to perform in-depth searches to find specific websites, guidelines and/or instructions.
• Report writing skills utilizing Cognos Power Play and Impromptu.
Normal office environment. Occasional overtime and after hours work may be required.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is frequently required to sit; use hands to finger, handle, or feel; and reach with hands and arms. Manual dexterity needed for using a calculator and computer keyboard. The employee is occasionally required to stand and walk and must occasionally lift and/or move up to 25 pounds.
The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or a logical assignment to the position.
This job description is to serve as a guide but no way is it to be considered a comprehensive list of task, duties and responsibilities that will be required by the employee.
To join our team of 2,350 employees and growing, please apply directly to this posting.
MedData is an equal opportunity employer.