EDI/ Claims Analyst

POSITION SUMMARY:

The EDI Claims Analyst is responsible for the oversight, timely, and accurate posting of claims electronic data interchange (EDI) errors as well as other Claims department tasks.

EXAMPLES OF DUTIES:

Responsible for accurately processing EDI Errors related to medical claims and dental claims

Review, research, and resolve EDI errors in accordance with policies through the utilization of reference materials and online tools

Consistently maintains department minimum productivity and quality standards while maintaining established accuracy guidelines

Provide feedback to the unit Manager regarding claims submission and system issues

Identify error trends that could result in a system enhancement to reduce errors

Electronic routing of claims letters

Scanning and importing documents into claims processing system

Create and work requests to coordinate eligibility and provider setup for posting of EDI errors

Must comply with privacy, integrity, confidentiality, availability and maintenance of Protected Health Information

Other projects as assigned

QUALIFICATIONS:

High School Diploma or equivalent

Basic computer skills/ Word processing/ Windows operative system and Google Workspace experience preferred.

1-2 years healthcare industry experience preferred

CPT, ICD-10, & HCPCS proficiency preferred

PHYSICAL REQUIREMENTS:

Sight within normal ranges, with or without use of corrective lenses

Finger dexterity

Ability to be stationary for long periods of time

Ability to lift 10 to 15 pounds

Access to PHI:

Routine & re-occurring access to all forms of PHI – The duties of the position require regular and unrestricted contact with PHI.

X Routine and limited and does not require manager approval - The duties of the position require routine contact with a limited set of PHI that does not require manager approval. Examples include claims adjudication.

Pay Range: $16.66 - $23.20 Hourly

ABOUT FIRST CHOICE HEALTH:

First Choice Health, headquartered in Seattle, WA, is a provider-owned healthcare organization offering employers a forward-thinking alternative to traditional health insurance. We have been serving employers of all sizes and across many industries with exceptional health benefits administration for over 35 years, providing unparalleled access to a growing number of clinically integrated networks (CIN) and a traditional PPO. Alongside our Employee Assistance Program (EAP) addressing mental health and work-life balance, our services collectively support members in every step of their healthcare journeys.

At First Choice Health, we are proud to deliver the personalized, quality service our clients deserve, while reducing costs and keeping their members healthy.

OUR PURPOSE, VALUES & CULTURE:

Uniting providers, employers, and individuals, we deliver sustainable solutions that elevate the health and care of our communities.

CARE TRANSPARENT COLLABORATE RELENTLESS INNOVATE

We strive to uphold the above values and take steps to cultivate our culture through each one. We work as a community, guided by our values and are unified in our mission to make healthcare access easier for everyone from all walks of life. Learn more about how we foster a culture of belonging.

At First Choice Health, we believe that a culture that fosters belonging- one that accept employees for who they are, nurtures creative thinking, and appreciates different perspectives drives our success. By cultivating an environment where every voice is valued, we empower our employees to bring their best selves to work, enable us to serve our clients and communities more effectively. We work as a community, guided by our values and are unified in our mission to make healthcare access easier for everyone from all walks of life.

BENEFITS:

Taking care of our employee's well-being is at the heart of our organization, with that we offer a wide range of benefits that to ensure our employees health are supported.

Medical & Vision- We offer two medical plans for employees, High Deductible and PPO plan for employees to choose from.

Dental- A dental plan through Sun Life dental is available to employees and eligible dependents.

Health Savings Account (HSA)- Employees who enroll in our medical plan can choose to establish a health savings account if eligible. FCH makes contributions to the HSA and employees may contribute pre-tax dollars via payroll deduction up to the IRS allowable limits.

Flexible Spending Account (FSA)- Employees may contribute pre-tax dollars through payroll deduction to a limited vision/dental FSA. Unlike with an HSA, unused FSA funds do not rollover from year to year.

Life Insurance- FCH provides life insurance benefits at no cost at a limit of two times an employee’s annual base salary (with a max of $300,000). Employees have the opportunity to purchase additional life insurance for themselves and their dependents through payroll deduction.

Short & Long-Term Disability Insurance- FCH provides long-term and short-term disability coverage to all employees. It is a shared cost benefit where FCH pays for the long-term benefit and employees pay for the short-term benefit.

Personal Leave and Sick Time- FCH employees enjoy the benefit of paid time off. Vacation, sick leave, and any personal leave are combined into a general annual PTO bank. PTO accruals are based on service on a pay period: 0-1 year of service – 120 hours; 1-2 years of service – 136 hours; 3 + years of service – 168 hours.

Paid Holidays- Each employee receives 13 paid holidays. 16 hours per year are available for community services, usable in four-hour or eight-hour time blocks.

Employee Assistance Program (EAP)- FCH recognizes that a variety of problems can disrupt personal and work life. If an employee needs professional help, they can contact the EAP, which provides confidential access to professional counseling services for help in confronting personal problems such as alcohol/substance abuse, marital and family difficulties, financial or legal troubles, or emotional distress.

Retirement Plan 401(k)- We contribute 50% of the employee’s 401k deferral, up to a maximum of 3% of the employee’s gross salary. Eligible employees must be at least 21 years old, and be employed with FCH a minimum of 90 days.

Profit Sharing - FCH may make annual discretionary profit sharing contributions in an amount to be determined at Plan Year end.

Tuition Reimbursement - Employees may be eligible to receive reimbursement for continuing education for Bachelor’s program after one year of employment with the company.

Wellness- We encourage and promote healthy behaviors through a Wellness program that offers rewards for those that participate.

These benefits may be changed with or without notice at any given time.

For California employees, please review Privacy Act: