EDI Specialist, Healthcare
Location
Philippines
Posted
16 days ago
Salary
₱25K - ₱30K / month
Seniority
Mid Level
Job Description
EDI Specialist, Healthcare
Vector Outsourcing Solutions Philippines
• Submitting medical claims to the proper clearinghouse for the insurance payers to review and make the proper decision and payments • Processing & monitoring of all claim reports & electronic documents. (Electronic and Paper Claim Transactions) • Logging in and tracking all submission and rejection information • Responsible for obtaining edit reports and repair claims for re submission, test, and ensure repairs are made in a timely manner • Make sure that the claim was sent to the proper clearinghouse • Backup the EDI claim submission and logging of information • Keeps an update of Policy, Regulations and Payer/Clearinghouse changes • Coordinating & testing all Electronic Data Interchange (EDI) implementations with new EDI partners & current clearinghouse • Coordinate and work with clearing houses or trading partners to resolve EDI issues such as rejection and submission errors • Collaborate with payers, clearinghouses and/or trading partners to successfully maintain the EDI processes • Test, implement and document all processes required by the new accounts or new billing software • Reviews, analyzes and coordinates implementation for service modifications by EDI ( new payer ID, claim edits) • Monitors daily EDI performance, analyzes complex datasets, and troubleshoots issues and resolve them in a timely manner • Facilitates the successful on-boarding of new Clients EDI accounts • Assure interfaces (ECPP, QRSP, and HPNA) are performing as designed • Assure data integrity (correct files/batches are uploaded) • Manage the resolution process as needed (Coordination with Team, Leaders, account Manager) • Escalate EDI issues to Manager/ Credentialing if unable to resolve in a timely manner • Manage Send/Receive Files, Work Rejected claim (daily) • Random Claim Status inquiry • Claim File Reconciliation (batch received by charges and batch submitted by EDI) • Analyze Rejection and detection of error patterns that need correction on the billing end
Job Requirements
- At least 2 years of experience in Healthcare EDI, Medical Billing, or Claims Processing
- Knowledge of EDI processes, claim submissions, clearinghouses, and rejection management
- Familiar with healthcare insurance payers, claim edits, and reimbursement processes
- Experience using EHR/EMR systems and billing software is preferred
- Strong analytical, problem-solving, and organizational skills
- Excellent communication and coordination skills
- Detail-oriented and able to work in a fast-paced environment
Benefits
- Maternity & Paternity Leave
- Medical / Health Insurance
- Paid Holidays
- Paid Vacation Leave
- Paid Sick Leave
- Equipment/ company computer is provided
- Php 1,000 De Minimis
- Php 1,000 monthly bonus upon regularization
- HMO upon regularization
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