Under the leadership of Patient Financial Services (PFS) management, the EDI Billing Specialist is responsible for timely and accurate billing of all claims for physician and/or hospital services and may include patient services identified as "Special Billing," including client, clinical trials, international, purchased services, occupational health, solid organ and BMT services. Monitor, direct, or correct all unbilled and pending claim rejections. The EDI Billing Specialist's objective is to develop, coordinate, implement, and manage electronic claims rejections. Additionally, the EDI Billing Specialist serves as the primary link between the business and all data-trading partners (client, claims processing, clearinghouse and other data providing or receiving partners); Day to day responsibilities include establishing contact with trading partners, analyzing the data exchanged with any partners, observing data records to record any errors, and correcting any failures and staging the received data for billing operations use. Working with all levels of the organization to support accurate, proper data exchanges within the organization.
High School Diploma or equivalent required. Bachelors preferred.
Minimum three years relevant work experience in hospital billing/coding or healthcare business office experience.
Must possess an advanced knowledge of various types of insurance plans.
Understanding of Managed Care contracts, denials and payor methodology.
Must have thorough knowledge of billing invoicing practices such as CMS UB and EDI (Electronic Data Interchange).
Expert with clearinghouse rejections, demographics, and modifiers.
Ability to work in fast paced, deadline driven environment.
Effective oral and written communication skills.
Keyboarding accuracy and math aptitude skills.
Medical terminology, knowledge of insurance and reimbursement procedures preferred.
Prior experience with Epic Hospital Billing Resolute preferred
Internal Number: 39016
About Cook Children's Health Care System
Cook Children's Health Care System is a not-for-profit, nationally recognized pediatric health care organization comprised of eight entities – a Medical Center, Physician Network, Home Health company, Northeast Hospital, Pediatric Surgery Center, Health Plan, Health Services Inc., and Health Foundation.Cook Children's Medical Center Based in Fort Worth, Texas, the integrated system has more than 60 primary and specialty care offices throughout North Texas. Its service region includes Denton, Hood, Johnson, Parker, Tarrant and Wise counties, with an additional referral area encompassing nearly half the state.Cook Children's traces its roots back to 1918, but throughout its continual change and robust growth, it still embraces an inspiring promise – to improve the health of every child in its region through the prevention and treatment of illness, disease and injury. To live up to this promise, Cook Children's combines the art of caring with the use of leading technology and extraordinary collaboration to provide exceptional care for every child, every day.History – Cook Children's has a rich history of nearly a century of caring for children.Our Promise – Knowing that every child's ...life is sacred, it is the promise of Cook Children's to improve the health of every child in our region through the prevention and treatment of illness, disease and injury.Companies – Based in Fort Worth, Texas, Cook Children's is a not-for-profit organization that is comprised of eight nationally recognized companies.Community Health Outreach – Cook Children's Community Health Outreach works together with over 150 partner organizations to improve the safety and health of at-risk children through education, disease and injury prevention and support.Clinical Research – Cook Children's is home to a skilled team of research-minded physicians, nurses and health care professionals and administrators who drive our commitment to excellent clinical care and the search for medical advances.Public Relations – Cook Children's Public Relations works with national and local media outlets, produces Cook Children's publications, coordinates special events and helps develop key relationships within the community.Contractor & Vendor Information – Cook Children's contractors and vendors must ensure their employees are knowledgeable about working with our organization.Sponsorship guidelines – Cook Children's sponsors a select number of events that are strongly aligned with its promise to improve the health of every child in the region through the prevention and treatment of illness, disease and injury.