Electronic Data Interchange Specialist

The Electronic Data Interchange Specialist will be responsible for assuring all claims that are processed through Electronic Medical Records and Practice Management Software are correctly billed and compliant. Validation through claim edit software before processing to the clearinghouse is essential. The Electronic Data Interchange Specialist will conduct random audits for proper coding of CPT codes vs. diagnosis codes and therefore must stay current with all insurance policy, CPT, HCPCS, and ICD-10-CM code changes throughout the year., * Be able to meet daily, weekly, monthly production and quality standards set for the position.

• Follow up on complex insurance denials or unpaid insurance balances.
• File appeals and update patient demographics.
• Identify trends and report up.
• General knowledge and application of Medicare, Medicaid, Commercial insurance guidelines, claims appeal processes.
• Performs other duties and projects as needed., * Patient First - Keeping the patient at the center of everything we do
• Accountability - Taking responsibility for our actions
• Commitment & Care - Upholding FCS vision through every action
• Team - Working together, one team, one mission

Expectations for all Employees

Every FCS employee is expected to regularly conduct themselves in a professional and respectful manner, to comply with all labor laws, workplace policy and workplace practices. Employees are expected to bring issues of any forms of workplace harassment, discrimination, or other potential improprieties to the attention of their management or the human resources department.

Do you have experience in Regulatory compliance in claims processing?, Do you have a High school diploma or GED?, * High School diploma or GED required.

• CPB, CPC, CPC-A, CCS, or CHONC preferred., * Minimum of two (2) years of experience in medical billing, coding, or insurance collections required.
• Ability to read and interpret documents such as payer medical policies and explanation of benefits (EOB).
• Understanding of insurance billing process and claim form completion.
• Knowledge of medical terminology, coding terminology (CPT, ICD-10-CM, HCPCS), and insurance/reimbursement practices.
• Medical Oncology, Radiology, Radiation, Laboratory, or Pathology experience preferred., * Analysis & Critical Thinking
• Strong interpersonal skills to include effective verbal and written communication
• Solid time management with the ability to prioritize multiple tasks
• Ability to collaborate across various levels of management, departments, and teams
• Comfortable negotiating problems and exploring solutions with physician population

Pulled from the full job description

• Tuition reimbursement
• 401(k) matching, At Florida Cancer Specialists & Research Institute, we believe our people are our strength and we invest in them. In addition to having a positive impact on the people and communities we serve, associates benefit from significant professional opportunities, career advancement, training and competitive wages.

Offering competitive salaries and comprehensive benefits packages to include tuition reimbursement, 401-K match, pet and legal insurance.

Since 1984, Florida Cancer Specialists & Research Institute & Research Institute (FCS) has built a national reputation for excellence. With over 250 physicians, 220 nurse practitioners and physician assistants and nearly 100 locations in our network. Utilizing innovative clinical research, cutting-edge technologies, and advanced treatments, we are committed to providing world-class cancer care. We are recognized by the American Society of Clinical Oncology (ASCO) with a national Clinical Trials Participation Award, FCS offers patients access to more clinical trials than any private oncology practice in Florida. Our patients have access to ground-breaking therapies, in a community setting, and may participate in national clinical research studies of drugs and treatment protocols. In the past five years, the majority of new cancer drugs approved for use in the U.S. were studied in clinical trials with FCS participation prior to approval.

Through our partnership with Sarah Cannon, we are one of the largest clinical research organizations in the United States. Often, FCS leads the nation in initiating research studies and offering ground-breaking new therapies to patients.