EDI Specialist (Healthcare) | Work From Home

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