Note: The job is a remote job and is open to candidates in USA. CenterWell Senior Primary Care is a leading healthcare services business focused on creating integrated and differentiated experiences for patients. The Home Healthcare Revenue Cycle EDI Systems Analyst will optimize revenue cycle systems, ensure compliance, and enhance system functionality while collaborating with cross-functional teams.
Responsibilities
- Support and configure revenue cycle applications utilized for billing and claims management
- Identify and implement process improvements to reduce denials and accelerate reimbursements
- Collaborate with FSU, IT and vendors to troubleshoot and resolve system issues and coordinate upgrades or integrations
- Monitor revenue cycle metrics such as errors, rejections and denial rates
- Utilize dashboards and reports to track and identify billing and collections trends
- Provide actionable insights to leadership for decision-making
- Ensure systems align with CMS, HIPAA, and payer requirements
- Respond to internal and external audit and data requests
- Support staff with system use and system issues
- Manage, analyze, and optimize electronic data transactions (837, 835, 270/271, etc.) between the FSU and external vendors
- Collaborate with clearinghouses and payers to resolve transmission, billing and adjudication errors
- Ensure timely submission of claims and receipt of remittance advice
- Partner with internal and external teams to ensure system functionality supports departmental and company goals
- Work with finance to reconcile payments and resolve discrepancies
- Support and train staff on System functionality, EDI processes and best practices
- Evaluate current workflows and recommend enhancements to improve efficiency, reduce costs, and ensure accurate and timely billing
- Collaborate with cross-functional teams to implement new procedures and track effectiveness
Skills
- 3 or more years of experience in healthcare revenue cycle and EDI, preferably in home health or post-acute care
- Strong knowledge of HIPAA transactions (837, 835, 270/271, etc.), EMR/EHR systems, and clearinghouse platforms
- Analytical skills with proficiency in Microsoft Office applications
- Understanding of healthcare regulations, reimbursement models, and compliance standards
- Excellent problem-solving, communication, and organizational abilities
- Bachelor's degree in Health Information Management, Computer Science, Business Administration, Healthcare Management, Data Analytics or related field, or equivalent experience
- Experience with revenue cycle automation tools and workflow optimization
- Familiarity with Medicare/Medicaid billing processes specific to home health
- Proficiency in file transfer software
- Project management or process improvement experience
Benefits
- Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being.
- Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work.
- Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
- Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
- Home or Hybrid Home/Office employees will be provided with telephone equipment appropriate to meet the business requirements for their position/job.
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