athenista Spotlight: Meet the Electronic Data Interchange Team
Processing claims on behalf of all our clients, they’re the heart of athenahealth’s services. And they truly enjoy the detective work of reconciling every submission, ironing out electronic submission wrinkles and getting clients’ claim submission questions answered. Maybe that’s why they’re the highlight of the athenahealth corporate tour. Meet the Electronic Data Interchange group, this month’s featured athenista team.
athenaPulse: Tell us about the Electronic Data Interchange (EDI) team.
Alicia: We’re responsible for submitting claims on behalf of clients, and making sure that process is as smooth as possible.
Katherine: We make sure every claim goes into a billing batch. (We group claims and send them out together in a batch.) If a claim doesn’t go out, we review it and see where the problem is. This year, 86% of our claims are submitted electronically. We’re hoping to push that to 87% by the end of the year.
David: We handle questions that come up on just about anything – if a provider number isn’t right, if there’s missing information on a claim, or any other reason the claim isn’t getting processed correctly.
Katherine: And we help clients get their claims adjudicated as quickly as possible.
Alicia: We’ve been very involved in the National Provider Identifier (NPI) transition [see April and May Pulse stories]. We also monitor any new payers that are going electronic so we can begin to submit electronic claims on behalf of clients.
Katherine: Medicare has required electronic claims submission for both primary and secondary claims. We’re helping our clients pushing forward with secondary claim submissions for other payers as well. Now, 42% of all our secondary claims submissions are electronic.
athenaPulse: What do you enjoy most about your work?
Jack: Making a difference. We get to track down all kinds of complicated details – operational breakdowns, tracking the custody of a claim, problems with electronic submissions – and resolve those for the client.
David: It’s detective work. We especially enjoy “cases” we get from other athenahealth departments. If other groups haven’t been able to crack a challenge, sometimes we’ll look at it and immediately know how to address it.
Shon: Working together as a team is great. I’ve only been here a few weeks, but there’s a great attitude and my colleagues are very helpful.
Laureen: And we all have a pretty good sense of humor.
athenaPulse: Your favorite “athenahealth moment?”
Reuben: Walking into work one day and seeing Jonathan Bush held aloft in full Batman costume.
Katherine: A few months before we moved to our Watertown location, we toured the new buildings. They handed out hardhats and glasses of champagne to everyone. It was a real construction site then.
David: We always enjoy the corporate tours. When prospective clients come through our offices, many of them sign up to be clients that day. We like to think we’re the highlight of the tour. Every client enjoys seeing how their claims will be submitted – how much work we’ll be saving them.
Alicia: Not to mention all the tools and resources at our fingertips to solve problems and get claims processed faster. Practices alone just don’t have that capacity.
athenaPulse: How do you unwind after work?
Reuben: Alicia and I play in athenahealth’s soccer league.
David: I play trumpet in a big band. We do swing music and we’re getting involved in some big band revivals and dances.
Laureen: I volunteer at the Home for Little Wanderers. I also love getting away to my small condo in Maine – I stress SMALL because we can’t accommodate that many visitors!
Rich: I come from a big Irish family – my mother is one of nine. I’m single but there’s never a shortage of family to spend time with.
Shon: I enjoy playing Madden Football.
Jack: I’m raising rugrats and Rhode Island Red chickens. (My rugrats are my two children, three and one.)
Stanley: I’m enjoying my new role as Acting President of my alumni association.
Katherine: I like to go home and spend time with my Labradoodle puppy. She chewed up my cell phone last night but didn’t swallow any parts – what a good girl!
