The PFS EDI Analyst/Charge Specialist at Foundation Health Partners (FHP) is responsible for ensuring the accuracy, integrity, and efficiency of electronic claim and charge processes within the Patient Financial Services department. This role manages and supports all electronic data interchange (EDI) functions, including claim submissions, remittance processing, and charge reconciliation, to ensure compliance with payer and regulatory requirements. 

Pay & Benefits:

• Compensation: $25.88 to $40.44 wage based on experience and education
• Additional Pay: Shift Differential for weekends, Annual Increases, Paid Time Off
• Benefits: medical, vision, dental, 401k with employer match
• Education Benefits: FHP Tuition Assistance, Student Loan Forgiveness
• Other Benefits: Onsite Gym, Wellness Programs, Discount programs, The Learning Center (childcare services)
• Schedule:
  • 40 hours per week, 5x8 hour day shifts, M-F

This position oversees the daily automated billing and posting job streams within assigned departments; identifies errors and exceptions; trouble-shoots and corrects errors, entailing posting and reconciliation of transactions. Uses coding software and the company's Charge Description Master (CDM) to audit billings and charges to ensure accuracy and appropriate reimbursement. This position works with clinical departments to implement new charging practices and ensure appropriateness of charging and documentation protocols.

About Fairbanks Memorial Hospital
Fairbanks Memorial Hospital is a non-profit facility owned by the Greater Fairbanks Community Hospital Foundation. A Joint Commission-accredited facility with 152 licensed beds, Fairbanks Memorial Hospital is the primary referral center for residents of Alaska's interior with a strong patient-to-nurse ratio and Shared Leadership Infrastructure. In addition to our exceptional clinical environment, our location offers incomparable lifestyle rewards away from work. In Fairbanks, small-town living, spectacular natural beauty and endless recreation combine to create a one-of-a-kind place to live, work and play.

1. Monitors daily translation and transmission of electronic billing claims and printing of payer claim forms, including identifying and correcting errors, and ensuring balancing of all activities by extracting crucial data elements and performing analysis on results.

2. Researches and evaluates third party claims, company's edits, and modifications with payer units to validate appropriateness for billing processes. Validates compatibility of new or requested edits with existing billing processes and procedures. When appropriate, submits requests for edits to claim scrubbers and tests edits once they are built.

3. Researches, implements and tests new lines of electronic billing and posting, and conducts other projects requiring carrier and vendor contacts and internal reviews.

4. Monitors daily transactions and activities with insurance eligibility module. Runs weekly reports to provide usage and error feedback to pertinent registration and billing representatives. Leads projects and implementation for any new applications with vendor. Works with help desk to ensure server maintains workability.

5. Audits daily error reports in the coding/billing system and makes corrections. Matches, corrects and codes charges that do not drop to billing.

6. Identifies opportunities for improvement in clinical documentation. Provides guidance and education for staff in billing procedures and electronic medical records usage procedures for coding and billing requirements. Maintains a current knowledge of procedural terminology requirements and provides staff with updated information on reimbursement charges and documentation requirements. As assigned, develops and provides education for physicians and staff.

7. Works with finance, Charge Description Master (CDM) teams, and other charge/coding staff to develop and consistently maintain coding and billing database information. 

Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers of Foundation Health with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day.

High school diploma/GED or equivalent working knowledge. Additional education in information systems and

CPT/ICD coding standards or equivalent experience.

Requires three or more years of work experience in patient financial services and a broad understanding of patient management and accounting systems. Requires knowledge of medical terminology and an understanding of the laws associated with confidentiality, credit and collections. Effective communication and human relations skills are required.

Must have the ability to test, document and implement new application programs over various hardware platforms; the ability to analyze and resolve system application problems; and the ability to gather and analyze data elements from automated systems to troubleshoot and resolve data or application errors.

PREFERRED QUALIFICATIONS

Additional related education and/or experience preferred.

Foundation Health Partners is an EEO/AAP employer; qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.