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Edi 837 information

What is an EDI 837?

An EDI 837 is an electronic data interchange (EDI) transaction set used by healthcare providers to submit healthcare claim information to payers, such as insurance companies. The 837 form replaces traditional paper claim forms and streamlines the process of billing for medical services. It ensures that claims are transmitted securely, accurately, and in a standardized format, which helps reduce errors and speeds up reimbursement. There are different types of 837 transactions, including those for institutional, professional, and dental claims.

What are the key skills and qualifications needed to thrive as an EDI 837 specialist, and why are they important?

To thrive as an EDI 837 Specialist, you need a strong understanding of healthcare claims processing, EDI transaction sets (especially 837), and knowledge of HIPAA regulations, often supported by experience in healthcare IT or revenue cycle management. Familiarity with EDI translation software, clearinghouse platforms, and mapping tools like Sterling B2B Integrator or Edifecs is typically required. Strong analytical skills, attention to detail, and effective communication are essential soft skills for troubleshooting issues and collaborating with providers and payers. These skills ensure accurate and compliant transmission of healthcare claim data, minimizing errors and optimizing reimbursement cycles.

What are some common challenges faced by professionals working with EDI 837 transactions, and how can they be addressed?

Professionals working with EDI 837 transactions often encounter challenges such as ensuring data accuracy, managing compliance with HIPAA regulations, and troubleshooting rejected claims due to syntax or mapping errors. Staying updated with payer-specific requirements and understanding the nuances of healthcare claim data are crucial to minimize errors. Collaborating closely with IT, billing, and compliance teams can help resolve issues quickly and maintain smooth claim submissions. Regular training and leveraging robust EDI validation tools are also key strategies for overcoming these challenges.

What is the difference between Edi 837 vs Medical Billing Specialist?

AspectEdi 837Medical Billing Specialist
Primary RoleElectronic submission of healthcare claimsProcessing and managing healthcare billing and claims
Required SkillsKnowledge of EDI standards, coding, and claim submissionBilling procedures, coding, insurance verification
Work EnvironmentHealthcare providers, insurance companies, billing servicesMedical offices, billing companies, healthcare facilities
CertificationsOften requires knowledge of EDI standards, coding certificationsMedical billing certifications (e.g., CPC, CBCS)

While Edi 837 focuses on the electronic transmission of healthcare claims using specific standards, the Medical Billing Specialist handles the overall billing process, including claim submission, follow-up, and insurance communication. Both roles are essential in healthcare revenue cycle management but differ in scope and technical focus.

What are popular job titles related to Edi 837 jobs in Kansas?

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What job categories do people searching Edi 837 jobs in Kansas look for?

The top searched job categories for Edi 837 jobs in Kansas are:

What cities in Kansas are hiring for Edi 837 jobs?

Cities in Kansas with the most Edi 837 job openings:

Edi 837 jobs near you

Facets QA Lead

Tata Consultancy Service Limited

Kansas City, KS • On-site

$80K - $100K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted yesterday

Job description

Must Have Technical/Functional Skills
• Strong SME knowledge in Healthcare Claims Processing lifecycle
• Expertise in EDI formats 837 (P/I/D), 835, 834
• Hands-on experience in Facets (Claims + Enrollment modules)
• Proficiency in Azure DevOps (ADO) for QA tracking
• Knowledge of HIPAA compliance and payer systems
• 8+ years of experience in Healthcare QA/Testing
• 4+ years of experience as Test Lead in Facets projects
• Deep understanding of Claims Adjudication & Payment workflows
• Experience in handling claims denials, adjustments, and reprocessing
• Strong exposure to EDI claim and remittance transactions
• Experience in mocking and validating EDI files (837/835/834)
• Knowledge of ITS claims processing (SF, DF, RF)
• Experience in Member Enrollment workflows (Medicaid, Medicare, ACA)
• Understanding of Billing lifecycle for member enrollment
• Hands-on experience with ADO Test Plans, Test Suites, and Defect tracking
• Ability to perform data validation and reconciliation activities
• Strong experience in functional and end-to-end testing
• Familiarity with Agile/Scrum methodologies
• Excellent stakeholder communication and coordination skills
• Experience in risk identification, defect triage, and RCA
Roles & Responsibilities
• Lead end-to-end testing for Claims, Enrollment, and Billing modules
• Act as SME for Claims Processing and EDI transactions
• Validate Facets Claims and Membership workflows
• Design and execute test strategies, test plans, and test cases
• Perform EDI validation (837, 835, 834) including mock data creation
• Manage defect lifecycle, triage, and resolution tracking in ADO
• Ensure HIPAA compliance in all testing activities
• Validate ITS claims processing across SF, DF, RF flows
• Drive quality metrics, reporting, and release sign-offs
• Collaborate with business, development, and partner teams for E2E validation
Generic Managerial Skills, If any
• Leading and Mentoring team members
• Strong problem-solving and critical thinking
• Ability to work with minimal supervision
• Documentation and knowledge sharing
• Excellent communication
Salary Range: $80,000- $100,000 a year
TCS Employee Benefits Summary:
Discretionary Annual Incentive.
Comprehensive Medical Coverage: Medical & Health, Dental & Vision, Disability Planning & Insurance, Pet Insurance Plans.
Family Support: Maternal & Parental Leaves.
Insurance Options: Auto & Home Insurance, Identity Theft Protection.
Convenience & Professional Growth: Commuter Benefits & Certification & amp; Training Reimbursement.
Time Off: Vacation, Time Off, Sick Leave & Holidays.
Legal & Financial Assistance: Legal Assistance, 401K Plan, Performance Bonus, College Fund, Student Loan Refinancing.
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