EDI Administrator (Eligibility)

Billing EDI Administrator

At Labcorp, you are part of a journey to accelerate life-changing healthcare breakthroughs and improve the delivery of care for all. You'll be inspired to discover more, develop new skills and pursue career-building opportunities as we help solve some of today's biggest health challenges around the world. Together, let's embrace possibilities and change lives!

The Eligibility EDI Administrator is a subject matter expert responsible for evaluating vendor/payer system eligibility responses for content required to create successful business outcomes as well as providing direction and insight to support business decisions and Labcorp system or process changes to increase estimate and claim accuracy. This is a decision-making role and will be involved in projects requiring interaction with multiple areas and various levels of leadership. The position is also a HYBRID position where you will work three days onsite (Burlington, NC location) and two days remote.

• Leads complex projects and issue resolution efforts
• EDI liaison with vendors and payers, evaluates the quality and appropriate outcomes of the partner's EDI data, identifies specific issues or concerns and recommends partner improvements to overcome obstacles to successful eligibility verification and accurate estimate creation
• EDI leader for system modifications related to eligibility verification and estimate creation, guiding the best patient experiences and increasing credit card authorization for patient services. Participates in product development calls, defining business requirements, guiding prioritization and timeline, reviewing demos/prototypes, reviews and approves test plans and results.
• Conducts detailed data analysis for existing issues by utilizing industry, company, and process knowledge and extensive experience to troubleshoot, works directly with IT and the partner business and technical resources to obtain resolution, identifies total claim exposure, and provides expertise to efforts to triage for rescue and/or recovery of impacted claims.
• Routinely engaged with senior management to facilitate process improvements resulting in cleaner billing data, thereby improving DSO, reducing error handling, and improving customer satisfaction.
• Works closely with Payer Solutions and Patient Service Center/IOP teams to communicate updates in programs and processes, educating resources at all levels and asks specific questions to obtain the details needed to develop plans of action, or course corrections for how processes are done.
• Develops detailed strategic plans, complete with full risk assessments, mitigation steps, action registers with stakeholders, milestones, and timelines. Executes plans within required timelines, apprises senior management of status updates daily or weekly, alerts to obstacles and risks encountered, engages necessary resources to overcome and achieve deliverables, or provides clearly articulated reasons for delays.
• Coordinates external and internal resources for strategic initiative participation; provides direction and guidance to successfully drive accomplishment of key objectives.
• EDI leader for various special projects and tasks.
• Mentors and trains EDI Analysts and Sr. Analysts by providing insight to team members, creates, and conducts training content, develops new processes when needed and guide maintenance of master data related to the construction or use of EDI data.

• Bachelor's Degree and three years' relevant work experience or five years relevant work experience with no degree required
• Minimum three years direct healthcare billing EDI work experience required
• Self-motivated and able to manage multiple projects and priorities at the same time strongly preferred
• Excellent customer service with ability to maintain composure and respond thoughtfully, quickly and professionally to unexpected client or vendor questions, concerns and issues strongly preferred

• Exceptional attention to detail and problem-solving skills to evaluate, recommend and develop processes strongly preferred
• Excellent collaboration skills to work effectively with cross-functional teams
• Written and oral communication skills are essential to work with others located throughout a wide geographic area primarily via conference calls and email
• Intermediate to Advanced Microsoft Office skills (Excel, PowerPoint, Word, Access)
• Ability to communicate complex procedures clearly and concisely
• Flexibility and the capacity to manage and adapt to changing priorities quickly