Electronic Data Interchange (EDI) Claims Assistant

The Electronic Data Interchange (EDI) Claims Assistant will work in the EDI unit and will be responsible for all aspects of EDI production for UCSF Health Patient Financial Services, Medical Group Business Services, UCSF Benioff Children’s Hospital Oakland, By the Bay Health, UCSF Physicians Group, Community Connect clinic, and Community Hospitals. The EDI production supports all electronic claim production to various payers and clearinghouses, including Medicare, Medi‑Cal, Anthem Blue Cross, Blue Shield, Availity, Optum IEDI, Optum Exchange, Jopari, PNT, and Office Ally. Electronic claim generation represents approximately 95% of all claims production. Monthly claims volume processed can reach up to 150,000 claims for hospital billing and up to 400,000 claims for professional billing. The position also supports the Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT) processes for UCSF, MGBS, LPPHC, BCH Oakland, BTBH, UC Physician Group, Community Connect Partners, and Community Connect Hospitals. The ERA/EFT represent approximately 80% of all inbound payment transactions to all supported service areas. The role involves frequent contact with units in Patient Financial Services and other billing groups, as well as external partners such as health plans and EDI clearing houses. Frequent application access includes EPIC/APeX, Wells Fargo CEO portal, Clearinghouse EDI portals, ApplicationXtender, and Cirius Billing and Remittance Applications. Qualifications High school graduate or GED certificate. One or more years of EDI/ERA experience in a hospital billing office or vendor environment with experience in 837I, 837P, and 835 file types. Three or more years of related administrative experience. An in-depth understanding of all aspects of electronic billing. Good analytical and organizational skills, interpersonal, verbal, and written communication skills. Experience in computer operations, particularly file management and FTP processes. Knowledge of electronic billing systems (e.g., NGS online system, Cirius Prebill, and Remittance Manager). Basic knowledge of the Epic (APeX) systems. Ability to follow directions and written procedures. Must be a motivated individual with a positive attitude and exceptional work ethic. Maintain a working knowledge of copy and fax machines. Excellent knowledge of Microsoft Excel and Access. Basic knowledge of FTP functions. Computer software skills (e.g., Microsoft Office Suite). Knowledge of the mandated HIPAA regulations for security, PHI, and confidentiality is essential. Ability to work in Emeryville one day a week or more when required. Ability to legally work in the USA without any type of work Visa sponsorship. Preferences Insurance payment posting experience. Understanding of ICD10, CPT4, HCPCS, and DRG. Knowledge of insurance billing contracts, workers’ compensation, HMOs, PPOs, capitation, Medicare, Medi‑Cal, and HIPAA compliance program regulations. About UCSF The University of California, San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate‑level education in the life sciences and health professions, and excellence in patient care. It is the only campus in the 10‑campus UC system dedicated exclusively to the health sciences and home to five Nobel laureates. Pride Values UCSF is a diverse community and values professionalism, respect, integrity, diversity, and excellence—our PRIDE values—and is committed to equity in workforce and care delivery. Equal Employment Opportunity The University of California is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected status under state or federal law. Salary Information The final salary and offer components are subject to additional approvals based on UC policy. Your placement within the salary range depends on work experience and internal equity. For positions represented by a labor union, placement follows the collective bargaining agreement. Benefits information can be found at #J-18808-Ljbffr UCSF Health