Responsible for formatting of electronic claims and successful delivery of the claims to the clearing house; Tasks include QA and testing for bill templates in the billing systems and bridge routines, print commands, and mapping tables in the claim management software; Create and refine workflows for the team for achieving optimal performance; Ensure that claims created and sent out to payers conform to HIPAA standards; Provide assistance to claim review and billing review teams in optimizing and enhancing revenue collection by addressing payer requirements for billing; Utilize knowledge of claim adjudication and coordination of benefits to streamline revenue enhancement efforts; Test changes in processes to accommodate new HIPAA formats, e.g 5010, 7030, etc. ; Define analytical strategies for the verification and validation of the billing systems and ensuring that it meets all defined business requirements and associated functionality; Support all Setup teams and overall ROPS by serving as experts on claim formatting requirements (X12, NUBC, NUCC, etc.); Ensure all billing requirements are understood and tested thoroughly; Complete quality assurance for changes to claim formats including 837 transactions, paper claim formats, ePremis bridge routines, print commands, mapping tables, etc.; Document QA results thoroughly and ensure that all back up documentation is complete and accurate; Provide QA training documentation and provides oversight of teammate's speed and accuracy during the training period; Assist the team lead in streamlining and improving quality assurance processes by providing feedback and writing updated policy and procedures; Manage projects related to upgrades to Relay Health releases and report out to team leader and leadership on progress; Participate in testing billing system releases; Test upgrades for existing 837I/837p EDI X12 transaction processes
Require a Master degree in Electronics & Communication Engineering or Electrical Engineering or a related field and 2 years work experience in the job or in related occupation.
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We maintain a drug-free workplace and perform pre-employment substance abuse testing and background verification checks.
DaVita will consider qualified applicants who have criminal histories in a manner consistent with the law.