EDI Specialist, Healthcare
Philippines
Full Time
4 days ago
$25,000 - $28,000 PHP
No Sponsorship
Key skills
PHPCommunication
About this role
Role Overview
- 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.
- 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.
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
- Government Contribution (SSS, Pag-ibig, Philhealth)
- 13th Month Pay
- Paid Holidays
- Bereavement Leave
- Paid Vacation Leave
- Paid Sick Leave
- Work from Home
- Others: Equipment/ company computer is provided
- Night shift differential pay Php 1,000
- De Minimis Php 1,000 monthly bonus upon regularization
- HMO upon regularization