Healthcare Billing/EDI Support Analyst

2 weeks ago

Tampa, United States Inovalon, Inc. Full time

Inovalon was founded in 1998 on the belief that technology, and data specifically, would empower the transformation of the entire healthcare ecosystem for the better, improving both outcomes and economics. At Inovalon, we believe that when our customers are successful in their missions, healthcare improves. Therefore, we focus on empowering them with data-driven solutions. And the momentum is building.

Together, as ONE Inovalon, we are a united force delivering solutions that address healthcare's greatest needs. Through our mission-based culture of inclusion and innovation, our organization brings value not just to our customers, but to the millions of patients and members they serve.

Location:Hybrid. This position will require onsite presence two times a week at our headquarters in Tampa, Florida.

The Healthcare Billing/EDI Support Analyst assists in the maintenance of healthcare claim payer edits, transaction compliance and custom business rule development. Monitor transaction performance, research payer requirements and document business rules. Implementation of rules in the INOVALON Rules Engine logic tool. Identify and track payer transition events associated with Clearinghouse Operations and all products affected by transaction services.

Essential Duties and Responsibilities:

  • In depth understanding of Electronic Data Interchange
  • Responsible for accessing payer websites and compliance standards research
  • Monitor ServiceNow queues and CMP Ticket queues for cases regarding payer edit requests or custom business rules
  • Supporting other department team members 'real time' as they work with clients
  • Review correspondence from trading partners regarding changes that may affect ABILITY processes and customers
  • Perform the necessary research to maintain our goal of 99% FPA on transactions
  • Determine why certain claims have failed to process, failed to pay or rejected and take necessary actions to remedy
  • Other projects as assigned
  • Other duties as requested and/or determined
  • Maintain compliance with Inovalon's policies, procedures and mission statement;
  • Adhere to all confidentiality and HIPAA requirements as outlined within Inovalon's Operating Policies and Procedures in all ways and at all times with respect to any aspect of the data handled or services rendered in the undertaking of the position;
  • Fulfill those responsibilities and/or duties that may be reasonably provided by Inovalon for the purpose of achieving operational and financial success of the Employer.

Minimum Requirements:

  • Bachelor's degree or equivalent work experience required
  • Two or more years' experience working in Healthcare billing or RCM application support
  • Solid understanding of NCD, LCD, MUE and CCI related billing rules
  • Proven track record understanding institutional and professional claims billing requirements
  • Understanding of Medicare, Medicaid, BCBS and commercial payer business rules
  • Excellent verbal and written communications skills
  • Excellent time management skills
  • Self-motivated with strong organizational/prioritization skills
  • Ability to multi-task with close attention to detail
  • Proven ability to work effectively under pressure & meet deadlines

Travel:

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