EDI Director in Brentwood, TN at Parallon

Date Posted: 8/30/2018

Job Snapshot

Job Description

Parallon believes that organizations that continuously learn and improve will thrive. That's why, after more than a decade, Parallon remains dedicated to helping hospitals and hospital systems operate knowledgeably, intelligently, effectively and efficiently in the rapidly evolving healthcare marketplace, today and in the future. 

As one of the healthcare industry's leading providers of business and operational services, Parallon is uniquely equipped to provide a broad spectrum of customized services in the areas of revenue cycle, purchasing, supply chain, technology, workforce management and consulting. 

Parallon's purpose is simple. We serve and enable those who care for and improve human life in their communities.

Job TitleDirector of EDI & Billing

General Summary of Duties- Directs and coordinates EDI/Billing activities to assure that standards are adhered to and that the electronic claim filing process functions efficiently and accurately.

Supervisor – Chief Operating Officer

Duties Included but not Limited to:
􀂃 Manages and maintains the EDI/Billing processes on all PM systems, provide standards and effective electronic filing strategies.
􀂃 Provides ongoing training and education to EDI/Billing staff to ensure that policies and procedures are followed.
􀂃 Meets with the COO regularly (minimum one time per month) to effectively communicate and resolve EDI/Billing issues, set and prioritize goals, improve processes and review insurance and billing status.
􀂃 Meets with staff on a monthly basis to provide updates, resolve issues, set goals and maintain standards.
􀂃 Ensure secondary claims are submitted accurately and in a timely manner.
􀂃 Monitor department benchmarks and make improvements when needed to ensure benchmarks are met.
􀂃 Maintains master copies of scripted reports for automation process of billing/EDI functions.
􀂃 Works with Enrollment Services to ensure timely completion of EDI applications and entry of key master files into PM system.
􀂃 Manages, edits and provides monthly edit statistics for all markets and educates practice managers and training staff on opportunities for improvement. Develops and monitors Control Diamonds within the department.
􀂃 Reconciles invoices at month end to ensure accurate billings for utilized services.
􀂃 Trains Service Center and medical office personnel in electronic filing and data entry methods.
􀂃 Sees that patient billing submission is efficient and bills and collection letter are sent out according to set schedule.
􀂃 Maintains master copies of all clearinghouse reports.
􀂃 Oversees EDI /Billing services to ensure accurate and timely transmission of claims, payments, collect letters, and statements.
􀂃 Researches and initiates rollout of new products.
􀂃 Ensures schedules are adhered to, reports any delays to COO.
􀂃 Assist in development of enhancements for OnBase and PM systems.
􀂃 Other duties as assigned.
􀂃 Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”.

Knowledge Skills and Abilities- This position requires the following minimum requirements:

Qualifications: 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.

Education

Bachelor’s Degree in Business or related field required. If a desired applicant does not have a Bachelor's Degree, the requirement can be waived if they are currently in a Bachelor Degree program.




Experience
Minimum five years’ healthcare management experience with three of these years in the related area for the position. Relevant education may substitute experience requirement with Executive approval.

Certificate/License

None

Language Skills - Ability to read, analyzes, and interprets general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

Technical Expertise – some understanding of healthcare, including knowledge of healthcare terms and accounts receivable processes

Strategic Analysis - analytical Review skills and ability to make decisions based on analysis

Leadership - guides individuals and groups toward desired outcomes, setting high performance standards and delivering leading quality services

Tactical execution - oversees the development, deployment, and direction of complex programs and processes

Financial management - applies tools and processes to successfully manage to budget

Project Management - assesses work activities and allocates resources appropriately

Organization - proactively prioritizes needs and effectively manages resources



Mathematical Skills - Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area circumference, and volume. Ability to apply concepts of basic algebra.

Reasoning Ability - Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Physical Demands / Working Conditions– Requires prolonged sitting/standing, some bending, stooping, walking and stretching. Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment. Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports or other information. Requires lifting papers/boxes and pushing/pulling up to 25 pounds occasionally. Work is performed in an office environment or hospital setting. Work may be stressful at times. Contact may involve dealing with angry or upset people. Staff must remain flexible and available to provide staffing assistance for any/all disaster or emergency situations.

OSHA Category– The normal work routine involves no exposure to blood, body fluids, or tissues (although situations can be imagined or hypothesized under which anyone, anywhere, might encounter potential exposure to body fluids). Persons who perform these duties are not called upon as part of their employment to perform or assist in emergency care or first aid, or to be potentially exposed in some other way.