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EDI Specialist (Healthcare) | Work from Home

Key Facts

Remote From: 
Full time
Mid-level (2-5 years)
English

Other Skills

  • Analytical Skills
  • Problem Solving
  • Organizational Skills
  • Communication
  • Detail Oriented

Roles & Responsibilities

  • 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

Requirements:

  • Submitting medical claims to the proper clearinghouse for insurance review
  • Processing and monitoring claim reports and electronic documents
  • Obtaining edit reports and repairing claims for resubmission
  • Coordinating testing of EDI implementations with new partners

Job description

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

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