In-depth knowledge of Medicaid portals and EDI claims systems (837, 835, 276, 277, 834, 270, 271, 999). * Strong experience with reconciliation processes and a solid understanding of billing ...
In-depth knowledge of Medicaid portals and EDI claims systems (837, 835, 276, 277, 834, 270, 271, 999). * Strong experience with reconciliation processes and a solid understanding of billing ...
In-depth knowledge of Medicaid portals and EDI claims systems (837, 835, 276, 277, 834, 270, 271, 999). * Strong experience with reconciliation processes and a solid understanding of billing ...
In-depth knowledge of Medicaid portals and EDI claims systems (837, 835, 276, 277, 834, 270, 271, 999). * Strong experience with reconciliation processes and a solid understanding of billing ...
In-depth knowledge of Medicaid portals and EDI claims systems (837, 835, 276, 277, 834, 270, 271, 999). * Strong experience with reconciliation processes and a solid understanding of billing ...
In-depth knowledge of Medicaid portals and EDI claims systems (837, 835, 276, 277, 834, 270, 271, 999). * Strong experience with reconciliation processes and a solid understanding of billing ...
In-depth knowledge of Medicaid portals and EDI claims systems (837, 835, 276, 277, 834, 270, 271, 999). * Strong experience with reconciliation processes and a solid understanding of billing ...
In-depth knowledge of Medicaid portals and EDI claims systems (837, 835, 276, 277, 834, 270, 271, 999). * Strong experience with reconciliation processes and a solid understanding of billing ...
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?
| Aspect | Edi 837 | Medical Billing Specialist |
|---|---|---|
| Primary Role | Electronic submission of healthcare claims | Processing and managing healthcare billing and claims |
| Required Skills | Knowledge of EDI standards, coding, and claim submission | Billing procedures, coding, insurance verification |
| Work Environment | Healthcare providers, insurance companies, billing services | Medical offices, billing companies, healthcare facilities |
| Certifications | Often requires knowledge of EDI standards, coding certifications | Medical 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 Nebraska?
For Edi 837 jobs in Nebraska, the most frequently searched job titles are:
What job categories do people searching Edi 837 jobs in Nebraska look for?
The top searched job categories for Edi 837 jobs in Nebraska are:
What cities in Nebraska are hiring for Edi 837 jobs?
Cities in Nebraska with the most Edi 837 job openings:
Full-time
Medical, Vision, Life, Retirement, PTO
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Job description
DIRECTOR OF BILLING AND REVENUE CYCLE MANAGEMENT
We’re Palco. We provide the management, support, and systems behind self-directed programs—the services that help people hire, pay, and manage their own caregivers with confidence. With 25+ years of experience as a national provider operating in over 17 states, we keep people at the center of everything we do. Through innovative technology and decades of expertise, we help states and partners run stronger, more compliant, and efficient programs. Our mission is to challenge the status quo and build smarter, more human-centered solutions that put power back in people’s hands. Want to learn more about joining our team? Visit www.palcofirst.com to explore opportunities.
We are seeking a highly skilled and experienced Director of Billing and Revenue Cycle Management to oversee and optimize our Medicaid and Managed Care billing operations. The ideal candidate will have at least 3 years of experience in revenue cycle management and a track record of managing teams of 10-15 people. The Director will be responsible for day-to-day management of billing processes, ensuring timely and accurate billing, addressing claim denials, and overseeing collections. Additionally, this role requires a critical thinker who can collaborate across teams, train staff, and formalize operational procedures while maintaining a strong focus on performance metrics.
This is a remote position requiring strong technical skills, deep knowledge of Medicaid portals and EDI claims systems, and the ability to manage a growing team. The Director will work closely with payroll, client-facing teams, and IT to ensure smooth operations and resolution of billing issues.
Key Responsibilities:
- Lead and manage a billing team (10-15 people) in the home care space, ensuring timely and accurate billing submissions.
- Oversee the preparation and submission of Medicaid and Managed Care claims, including 837, 835, 276, 277, 834, 270, 271, and 999 files.
- Identify and address issues related to claim denials, rejections, underpayments, and overpayments, ensuring claims are resubmitted as needed.
- Develop and implement training programs for billing staff, ensuring they are well-versed in Medicaid and Managed Care billing procedures and company policies.
- Collaborate with cross-functional teams (e.g., payroll, client-facing teams, MCOs) to ensure seamless billing operations and efficient resolution of billing inquiries.
- Interface with IT teams to troubleshoot system issues and collaborate on technical solutions related to billing and claims processing.
- Monitor and track billing performance, ensuring collections targets are met and billing is completed timely each month.
- Reconcile billing accounts to the general ledger and ensure alignment between billing records and financial statements.
- Document and formalize billing procedures to improve efficiency, accuracy, and compliance with regulatory requirements.
- Analyze and interpret billing data, using Excel (VLOOKUPs, pivot tables) to provide actionable insights for management.
- Ensure compliance with all state and federal regulations (including HIPAA) and maintain up-to-date knowledge of Medicaid policies.
- Provide leadership in staff development, fostering a high-performance culture focused on accuracy, customer service, and team growth.
Required Qualifications:
- Advanced Excel skills are required, including proficiency with VLOOKUPs, pivot tables, and other formulas.
- 5+ years of experience in Medicaid billing and Managed Care programs, particularly in the home care space ideal
- Proven experience managing a team of 10-15 billing staff, with the ability to train, develop, and motivate the team.
- In-depth knowledge of Medicaid portals and EDI claims systems (837, 835, 276, 277, 834, 270, 271, 999).
- Strong experience with reconciliation processes and a solid understanding of billing, payments, and general ledger alignment.
- Ability to collaborate across departments (payroll, client-facing teams, IT, etc.) to streamline processes and resolve issues.
- Excellent critical thinking and problem-solving skills, particularly when addressing billing discrepancies and system issues.
- Strong training and development abilities, with experience in documenting and formalizing procedures.
- Ability to work independently and manage a team remotely.
- Previous experience with NetSuite or similar accounting software is a plus.
Join Us
- This position is remote/work-from-home role. Enjoy the convenience of working from home and maximize your time by unplugging at the end of your workday.
- Company benefits designed for you:
- Generous Paid time off.
- Annual bonus potential.
- Retirement Savings: We will support you as you save for your future.
- Career Growth Opportunities: We help you thrive, so together, we can grow. We provide opportunities to advance your career with a vast portfolio of businesses and a global footprint.
- Paid Training: Earn while you learn and continue to grow with access to internal and external learning opportunities.
- Great Work Environment: We are proud of our company culture of collaboration and the recognition we have received for our diversity efforts.
Benefits package:
- Employer shared Health Insurance cost
- Employer paid Disability Insurance
- Employer paid Life and AD&D Insurance
- Vision Insurance
- Cancer Insurance
- Voluntary Life Insurance
- Paid Time Off
- Remote work environment
- Paid holidays
When you join Palco, you are engaged in creating the future - both our company’s, the people we serve, and your own. We understand that our success is directly related to the success of our team. We strive to create a culture where you can:
- Bring your authentic self to work.
- Grow and thrive, both personally and professionally.
- Make a difference with our clients, in our communities, and with the millions of people we support.
- Experience work/life balance.
- Feel value and a greater purpose through the work you do.
Palco, Inc. is an Equal Employment Opportunity (EEO) employer and does not discriminate in any employer/employee relations based on race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law.