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EDI Analyst

EDI Analyst

Job ID 
Revenue Cycle Management
Employment Status 

More information about this job


The EDI Analyst plays a key roll within the CBO. This position is responsible for assisting the IDX Team and the other functions in the CBO to maintain daily claim production and perform analysis on Pinnacle’s accounts that are rejected during claim transmission / re-billing process. This individual performs data entry of anesthesia charges and corrections into the patient accounting system from supporting documentation to expedite the filing of claims. Additionally, this individual is responsible for working to identify, resolve and maintain system edits and train the staff on areas of improvement.


  • Review and work daily rejection report / queues to determine information needed to complete the billing process and / or the appropriate individual to help resolve outstanding issue.
  • Coordinate with other departments, the electronic billing vendor and supervisor to resolve barriers such as establishing new system edits or changing existing edits in accordance with payer requirements.
  • Inform the Management Team of any problems or changes in payer requirements. Exercise independent judgment to analyze and report repetitive edit failures so corrective actions can be taken.
  • Utilizing the Centricity EDI application, analyze and evaluate the processes associated with claims submission. Review and track claim rejections to identify and resolve existing or potential issues that would impact efficient and accurate claims adjudication and/or claim status. Communicate outstanding rejection issues to Management Team.
  • Work claims on hold to ensure all efforts are made to file the claim before the filing deadline.
  • Identify ways and methods to improve work processes and provide recommendations for new and/or revised procedures.
  • Well-developed problem solving skills, including the ability to identify appropriate solutions within the system, and follow through with the timely filing of the claim.
  • Report recurring rejected claims to management Team for evaluation of impact on the timely filing of claims.
  • Contact insurance carriers and other CBO departments and/or gather information on-line for claim transmittal.
  • Document all actions taken on accounts in the system account notes to ensure all prior actions are noted and understandable by others.
  • Maintain a positive working relationship with contacts at all agencies, patients, insurance companies, government entities, providers, other CBO staff and management, to promote teamwork, cooperation, and a positive image.
  • Possess exceptional communication and interpersonal skills in order to effectively interact with customers, department management and CBO staff.
  • Stay abreast of the latest developments, advancements, and trends in the field of revenue cycle management by reading professional journals and insurance newsletters.   Integrate knowledge gained into current work practices.
  • Maintain knowledge of applicable rules, regulations, policies, laws, and guidelines that impact billing.
  • Attend scheduled department meetings and training sessions.
  • Review claim reports for errors/rejections and make necessary corrections.
  • Identifies training needs and helps facilitate training as needed.
  • Maintains strictest confidentiality.
  • Perform other duties, as assigned


  • High School graduate or equivalent.       Associate degree preferred.
  • Minimum of three years of experience in a healthcare business office is required.
  • Requires at least 1 year of coding experience in a healthcare organization.

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