Electronic Data Interchange (EDI) Claims Assistant

Job title: Electronic Data Interchange (EDI) Claims Assistant

About the Role The Electronic Data Interchange (EDI) Claims Assistant will work in the EDI unit and be responsible for all aspects of EDI production for UCSF Health Patient Financial Services (PFS), Medical Group Business Services (MGBS), UCSF Benioff Children’s Hospital Oakland (BCH 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, Medi-Cal MC, 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. The position also supports the ERA processes for UCSF, MGBS, LPPHC, BCH Oakland, BTBH, UC Physician Group, Community Connect Partners, and Community Connect Hospitals. In addition, this position also supports Electronic Funds Transfer (EFT).

What You'll Do

• Work in the EDI unit and be responsible for all aspects of EDI production for UCSF Health PFS, MGBS, BCH Oakland, By the Bay Health, UCSF Physicians Group, Community Connect clinic, and Community Hospitals.
• Manage electronic claim generation to payers and clearinghouses, including Medicare, Medi-Cal, Medi-Cal MC, Anthem Blue Cross, Blue Shield, Availity, Optum IEDI, Optum Exchange, Jopari, PNT, and Office Ally.
• Support Electronic Remittance Advice (ERA) processes for UCSF and partner entities.
• Support Electronic Funds Transfer (EFT) processes.
• Acknowledge that Electronic claim generation represents the majority of claims production (approximately 95%).
• Handle high-volume processing with monthly claims volume that can reach up to 150,000 hospital claims and up to 400,000 professional claims.

What We're Looking For

• Experience with electronic data interchange (EDI) claims production and electronic claim generation.
• Knowledge of ERA (Electronic Remittance Advice) and EFT (Electronic Funds Transfer) processes.
• Ability to coordinate with multiple payers and clearinghouses (e.g., Medicare, Medi-Cal, Anthem Blue Cross, Blue Shield, Availity, Optum products, Jopari, PNT, Office Ally).
• Ability to manage high-volume claim processing with attention to accuracy and timeliness.
• Familiarity with hospital and professional billing and cross-functional collaboration across departments (PFS, MGBS, BCH Oakland, and affiliated clinics).