We have a RCM EDI Services Analyst Career opportunity for an experienced professional to join our team at Pediatrix Medical Group. We are a national organization, and one of the nation’s largest providers of prenatal, neonatal and pediatric services.

Talented business professionals from diverse backgrounds choose Pediatrix because we are an exciting and innovative company that focuses on a team approach to improve the lives of patients everywhere. We are confident that you'll love being a part of the Pediatrix team. 

The RCM EDI Services Analyst II will provide ongoing support to RCM Operations, act as the Project Lead for all projects, system implementations and upgrades across all RCM platforms and environments, to include but not limited to Patient Access, EDI Services, Data Operations, Business Systems, Patient Financial Services, NextGen Technology team, Information Technology (IT), Platform Services, Integration, Provider Enrollment departments, and internal and external vendor services.

In the RCM Support role, the Analyst II works closely with all listed departments to ensure continuity across all systems, test and production environments alike.

The Analyst II will consult with RCM leaders and internal and external departments, facilitates activity required, provide recommendations, and solutions related to workflow, day to day operational activities, and support to all related system, data integrity and exchange.

The Analyst II participates in all RCM projects, facilitating or taking directions from project leader which may include but is not limited to solicitation of end user input, mapping the workflow, assisting with data analysis and documenting project specifications. The Analyst II must also serve as quality assurance, UAT representative, for all implementation/upgrade scripts, including creating test scripts and release notes associated with assigned projects. 

Essential Duties:

• Creates and maintains all project related documentation including UAT scripts, enhancement change logs, release notes, workflows, and publications for training and HUB.

• Coordinate and monitor all activities including on-time delivery, testing and production implementations.

• Contributes to project update both verbally or written.

• Project testing, implementation, and application upgrade roles:

• Serve as individual contributor for functional test plans and user acceptance test plans and scenarios.

• Will manage multiple projects simultaneously or at any given time, in addition to day to day operation tasks.  

• Work collaboratively with IT developers, QA associates and vendor resources in data design sessions as required

• Work as a technical support and liaison to designated IT resources to provide testing, support and feedback on project requests and regular updates/releases; adhere to release schedules that may impact EOM or EOY goals.
• Maintain strict confidentiality in accordance with HIPAA regulations and Company policy.
• Any patient private health information (PHI) must not be divulged on any account except to payers that need the information to process the claim for payment.
• Presents a positive, professional appearance and conveys a professional demeanor in the performance of assigned duties.
• Performs other job-related duties within the job scope as requested by Management of RCM.
• Always embodies the principles of the corporate Mission Statement and Philosophy.
• Represents the corporation in a positive fashion and makes all individuals feel as comfortable as possible.
• Conducts all business in a professional manner always maintaining respect for individuals.
• Complies with departmental and company-wide policies and procedures.
• Maintains constant awareness of potential safety hazards ensuring necessary safety precautions.
• Reads and complies with established policies and procedures.

• Provide support in cross-functional areas within the department to include but are not limited to:
• All RCM Systems, System Optimizations/Maintenance/ProjectsGPMS Production System balancing/integrity validation: Monitor, QA, perform validation of jobs and system financial totals
• Submit, fulfill and monitor delivery of requests submitted via Service Now, email, from meeting takeaways.
• Manage system job schedules and documentation of special programs.
• Manages all special programs, ini parameters.
• Ensure all vendor placement files are created. Perform a periodic review of special program output and settings, updating as business requires.
• Performs system financial closes on a rotational basis 

• Work with Pediatrix Tech Ops team, Applications team, IS Development team, Security team, various vendors (print, clearinghouse, coverage insight and VisiQuate) to ensure all system issues are resolved to keep revenue going out the door and coming in

• Off hour and weekend work with Pediatrix Tech Ops team, Applications team and IS Development team to review and resolve system failures to ensure system access for all Pediatrix GPMS users and steady flow of revenue

• Perform routine daily operation duties to include but not limited to:
• Maintain, generate, validate delivery, and reconcile patient letters to print vendor
• Perform validation of daily claim processing to vendor
• Reconcile and commit all applicable reports to OnBase application  
• Research and submit ERA/EFT enrollment ticket requests to minimize missing 835 files and paper remittance sent by payers going through Health Logic
• Provide support of all Waystar claim rejection activity for GPMS and NextGen billing to identify trends, determine if claim logic is needed, and resolve issues at root cause
• Provides critical frontline support monitoring of GPMS X-import, X-constant activities from OBR and Master Data Interfaces.
• Frontline monitoring/adjusting of Nightly Auto Eligibility Batch processes -reports issues, assists with data integrity issues causing batch failures
• Manage and monitor Hearing Screen capitation set up and daily write-off activities based on capitation or Balance Billing regulations / contractual agreements. 
• Backup support to ERA/EFT Daily Auto Post batching and check release
• Elevate New Facility Report – Weekly reporting to Elevate for patient statement processing
• Monitor and perform daily reconciliation activities for key vendor placement files including claims, 835 remittances, claim status, letters, statements, bad debt, auto eligibility, insurance coverage detection
• Perform routine EDI/ERA/EFT/270 Eligibility Enrollments and follow up through approved vendor enrollment and tracking tools
• Monitors all Power BI dashboard tools to identify and provide recommendations on issues found, mitigate delays, optimize processes

Education/Experience:

• Associate's degree (A. A.) or equivalent from two-year college or technical school.
• 2 or more years related experience in healthcare administration and/or training; or equivalent combination of education and experience in Revenue Cycle Management.
• Demonstrated understanding of all RCM systems from a support standpoint.
• Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community.
•  Ability to effectively present information to RCM and other Department Leaders on projects related to the role
•  Ability to interpret, test and work with all X12 Data Sets and companion guides commonly used the healthcare and finance industry, such as Electronic Claims, Remittances, Claim Statuses or Eligibility Inquiries.
•  Must be able to work with IT and outside agencies or vendors to establish and test FTP, SFTP or other types of secure, encrypted file exchanges.
•  Ability to define problems, collect data, establish facts, and draw valid conclusions to resolve issues. Ability to interpret an extensive variety of technical instructions.
•  Ability to identify patterns, gather data, identify test data or provide support to the RCM Staff or upper management as needed.

Knowledge/Skills:

• Excellent verbal and written communication skills.
• Able to think methodically, identify problems, develop practical solutions, and assist the department leadership in implementation by partnering with peers and corporate business partners.
• Organizational skills and attention to detail.
• Working knowledge of EDI formats and Internet functions.
• Creative problem-solving required to design a system that meets department needs

Software:

GE Centricity, GPMS, NextGen, Online Billing Registration (OBR), Master Database. MS PowerPoint, MS Project, MS One Note, MS Excel.

Benefits for Full Time employees and qualified dependents: 

• Medical, Prescription, Dental, Vision Insurance
• Progyny Fertility Benefits
• Livongo Diabetes Management
• Teladoc Health and Second Opinion Services
• Smart Shopper
• 401(K) Thrift Program & Sharing Plan**
• Employee Stock Purchase Plan (ESPP) – 15% discount*
• Basic Employee; Spouse; Child Life Insurance
• Accidental Death and Dismemberment (AD&D)
• Employee Optional Life and AD&D
• Short & Long Term Disability
• Pre-Tax Health Savings Accounts (HSA)
• Employee and Dependent Flexible Spending Account (FSA)
• Family Medical Leave Act (FMLA)**
• Parental Leave Benefit
• Sick Pay Bank
• Employee Assistance Program (EAP)**
• Group Aflac Policies
• Identity Theft Protection
• Employee Charitable Fund
• Care.com
• Various Discount Programs

*Part Time Regular employee classifications also receive this benefit

**Available to part-time regular and part-time casual employees aged 21 and over

Pediatrix Medical Group is one of the nation’s leading providers of highly specialized health care for women, babies and children. Since 1979, Pediatrix has grown from a single neonatology practice to a national, multispecialty medical group. Pediatrix-affiliated clinicians are committed to providing coordinated, compassionate and clinically excellent services to women, babies and children across the continuum of care, both in hospital settings and office-based practices. The group’s high-quality, evidence-based care is bolstered by significant investments in research, education, quality-improvement and safety initiatives. 

Please Note: Fraudulent job postings/job scams are becoming increasingly common. All genuine Pediatrix job postings can be found through the Pediatrix Careers site: www.pediatrix.com/careers.

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All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.