EDI Specialist (Healthcare) | Work from Home

Salary: PHP 25,000 - PHP 28,000/ month

Job Description:

• 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.

Minimum Qualifications:

• 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

Perks and 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