Claims Administrator / Project Manager

FLSA Status

Exempt     

Job Role Summary

This position is responsible for managing payor enrollment, electronic claims submission, electronic remittance advice, electronic payments new sites, site conversions for all divisions, creates dashboards for operational leaders. Ensures claims are processed timely, in accordance federal and state laws, regulations and payor guidelines.  Manages an average of 475 K hospital claims ($28.8 B charges) and an average of 750 K professional claims ($144.2 M charges) per year for all divisions. Works closely with department leadership as well as vendors to solve and prevent claims issues through development and implementation of system logic, reducing manual processes, increasing efficient workflows supporting timely reimbursement for all services rendered for all divisions.  Manages and builds payor reimbursement contracts in EHR Contract Manager to monitor expected and actual reimbursement from all contracted payers.

Essential Functions and Responsibilities

• Proactively contributes to Eskenazi Health’s mission: Advocate, Care, Teach and Serve with special emphasis on the vulnerable population of Marion County; models Eskenazi Health values
• Manages claim imports and exports for EHR and vendor systems, adds payers, NPIs, locations and ensures timely completion of EDI, ERA, and EFT enrollments, and manages electronic claim forms, and system logic
• Reports trends in rejection, clean claim rates and recommends changes to resolve issues, develops, tests, implements and maintains claim edits and bridge routines 
• Creates and reports claims related dashboards to SLT
• Maintains contract manager within EHR for both HB and PB billing and manages reimbursement variances 
• Knowledge of current government and commercial payor billing and reimbursement requirements.  
• Conducts oral and written training of payor requirements and use/navigation of vendor systems
• Manages EHR work queues for external errors, denials, new locations.
• Ensures timely receipt of ERAs, works with vendor to obtain missing files. 
• Serves as security administrator for all payer websites, which includes managing user access to all payer portals, Clearinghouse, internal SharePoint site, and other required access needs for all divisions and external vendors
• Manages external vendor access and claim activity
• Manages multiple projects supporting efficient and timely claims processing
• Facilitates meetings with internal leaders and vendors

Job Requirements

• Bachelor’s degree in a business-related field, Health Information Administration, or related area required
• More than four years of experience directly related to hospital billing, coding, claims administration, or related roles may be accepted in lieu of degree
• EPIC HB and/or PB Contract Manager Certification required or must be obtained within 1 year
• Five plus years of billing experience required
• Epic and nThrive experience required
  •  Minimum of 5 years of related experience in a hospital/medical environment may be accepted in lieu of educational requirements
  •  Coding credential from AHIMA or AAPC required within 1 year
     

Knowledge, Skills & Abilities

• Excellent critical thinking, analytical, and problem-solving skills to research issues involving accounts, claim holds, and other issues impacting revenue.
• Excellent organization skills, must be able to manage multiple priorities and exercise initiative to ensure timely completion of responsibilities
• Detailed and multi-task oriented due to the large volume of data being collected and reported
• Excellent verbal and written communication, and organizational skills are required; ability to communicate issues to management, and other teams within Revenue Cycle and other operational areas including Patient Access, EPIC Teams, IT staff, vendors, and payers
• Extensive knowledge of uniform billing requirements, claim forms, and 837 transaction files
• Excellent analytical skills
• Ability to analyze reports, troubleshoot issues with claims, interfaces, and payer transactions impacting accounts receivable 
• Ability to import data, and to develop and build complex reports in Excel, nThrive and other systems 
• Extensive experience with Microsoft Word, Excel, and PowerPoint to design and manage reports
• Ability to learn software quickly; ability to manipulate and interpret data