Holista

Analyst

• Assist in modifying and maintaining SQL queries using SQL Server Management Studio.
• Support reporting initiatives and system enhancements.
• Serve as backup to the EDI Analyst II during absences.
• Attend internal and external meetings related to system builds and payer reporting.
• Analyze 277/834/835/837/999 EDI files for trends and discrepancies.
• Assist with AR analytics and revenue cycle performance reporting.
• Support payer issue investigations and claim data validation.
• Participate in system testing and validation for updates or changes.
• Maintain documentation for reporting workflows and processes.
• Collaborate with EDI & Operations Analyst on internal system efficiencies.

EDI Analyst I

Claims Specialist

• Research and resolve all claims and authorizations exceptions using internal resources.
• Provide communication to providers as necessary regarding the status of a claim or authorization.
• Follow up with providers on all financial implications of reprocessed claims or authorizations.
• Transport all claims entered by processors from image software to proprietary software for review.
• Utilizing knowledge of system, research current queues of work to find claims requiring further research and correction.
• Research and resolve any claim and authorization issues to determine best resolution.
• Work with internal departments to resolve issues involving authorization or claim handling.
• Recoup any overpayments to providers resulting from changes to a claim or authorization processing by posting to the provider account.
• Log all claims and authorizations that cannot be resolved and send rejection letters to providers.
• Using knowledge of authorizations, hold certain payments pending the outcome of client review.
• Adjudicate claims and send for payments ensuring that all proper documentation is attached.
• Complete daily audit of claims entered by Claim Intake representative.
• Take any incoming calls from providers or members regarding authorizations, benefits, or claim status.
• Provide backup to Accounts Receivable Assistant or Authorization Representative as needed.
• Develop and/or communicate methods to improve productivity and efficiency.
• Assist with gathering data for client audits.
• Contribute to the team effort by accomplishing additional responsibilities as needed.
• Assist with training of new staff members.

Customer Support

• Support daily EDI operations including monitoring claims submissions and remittance processing.
• Assist with AR, claim corrections and authorization-related workflows.
• Coordinate with Claims and Authorization departments in alignment with check runs.
• Work closely with the EDI & Operations Analyst on special projects and system improvements.
• Assist in reviewing 277/834/835/837/999 files for errors or inconsistencies.
• Track payer issues and support documentation efforts.
• Participate in testing for system updates when needed.
• Maintain organized records of EDI transmissions and payer communications.
• Provide operational support during peak workload periods.

EDI Analyst I

Claims Specialist

EDI Support Specialist