TEAM LEAD EOB & ERA PROCESS AUTOMATION

FLSA Status

Job Role Summary

The Team Lead/EOB and ERA Process Automation position utilizes technology to streamline and improve timeliness of 835 file postings and exceptions within Revenue Cycle related to all Eskenazi Health Professional Billing, Hospital Billing, and ancillary billing areas.   This position works closely with various departments to elevate awareness of system issues, offer change proposals, and works with impacted areas to resolve workflow deficiencies or gaps.  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

Essential Functions and Responsibilities

• Utilizes technology to streamline and improve timeliness of 835 file movement, posting, and adjustments within the patient accounting systems 
• Works with appropriate department leadership to discuss problems, needed changes, and to develop workflows and procedures prior to implementation of new processes
• Participates in system build and implementation testing, provides leaders feedback regarding system changes and departmental impact 
• Monitors incoming ERA’s to ensure continued functionality, works with business owner(s) to make changes 
• Monitors incoming 835’s for appropriate payor name, reloads and renames files when needed, follows up with Claim Administrator to resolve file naming issues at the Clearing House when appropriate
• Manages key performance indicators for payment posting team and reports results of payment corrections and adverse payor trends to Cash Management Leadership and end users
• Maintains accuracy of payor site data for payment of claims (i.e. regularly updates Reg Codes with Payspan, audits enrollments for payment with various payor URL’s, in many instances functions as a Super User or Site Admin for payor websites) 
• Works with Epic teams, internal Interface Team, banking business partners (regarding data submission and file movements), Claims Admin and Clearing House key technical resources; resolves breaks in processes or initiates improvement of payment application processes.  Works independently in the investigation and research of found issues and leads the efforts for improvement and resolution of technical issues 
• Works with Billing Leadership for the investigation of technical issues surrounding inappropriate payment/adjustment application to claims. Provides key leadership and drives resolution of technical issues identified by billing team members, offering feedback upon completion of tasks 
• Works with Customer Service leaders and vendors to investigate and resolve inquiries received from patients and insurers. Research technical issues to determine root cause and appropriate resolution; provides feedback
• Develops and updates user documentation relating to the most effective and productive use of the system.
• Communicates system issues, payor trends, and contract non-adherence to the appropriate management position
• Provides technical documentation and updates associates with operational needs and audit requirements
• Ensures accurate and timely posting of all EOB and ERA payments, discounts, and denials for patient accounts within 24 business hours of deposit
• Monitors PLB postings within Clearing Accounts, provides feedback of payor trends and resolution of items requiring research or special attention.  Works to resolve outstanding PLB items as assigned, and assists payment posters with difficult transactions as needed
• Trains associates in appropriate account selection by date of service and /or total charges to ensure proper payment / discount application ensures correct usage of batch numbers, batch comments, and deposit dates to facilitate research capabilities.
• Ensures documentation of EOB / ERA reimbursement explanation in multiple patient accounting systems, according to departmental protocol.
• Files batch information including checks and EOBs in an organized manner.  Manages daily work assignments from Lockbox file in patient accounting system to facilitate payment posting workflows.
• Identifies manual posting errors and provides coaching in the way of communicating with the cash posting team on areas of needed improvement.  Gives regular updates to Cash Management leadership regarding errors and quality audit findings

Job Requirements

•    Associate’s degree or equivalent experience required, preferably in business, health or public administration, management, or a related field
•    Minimum of four years of related experience in a hospital/medical environment may be accepted in lieu of educational requirements 
•    Must be capable of typing a minimum of 40 wpm
 

Knowledge, Skills & Abilities

•    Demonstrates advanced knowledge of EOB / ERA formats and payor reason codes to effectively document the patient account.
•    Advanced analytical skills with a strong aptitude for logical data flow
•    Clear effective verbal and written communication skills.
•    Ability to multi-task
•    Skills in multi-tasking between multiple systems, including strong analytical, data management and MS-Excel skills
•    Professional, team-oriented, solution-driven approach to problem solving for all types of issues
•    Detail oriented and possesses effective project management skills
•    Must have strong attention to detail
•    MS-Excel and other business office software/tools