EDI Consultant Healthcare Work From Home

Vector Outsourcing Solutions Philippines; Manila; Remote; PHP 279,000 - 391,000; Full time

Benefits offered by this job

Maternity & Paternity Leave

Government Contribution (SSS, Pag-ibig

13th Month Pay

Paid Holidays

Bereavement Leave

Paid Vacation Leave

Paid Sick Leave

Work from Home

Night shift differential pay

Php 1,000 De Minimis

Php 1,000 monthly bonus upon regulariz

HMO upon regularization

Job summary

Vector Outsourcing Solutions Philippines is seeking an EDI/Medical Billing Specialist to submit claims to clearinghouses, monitor electronic documents, and coordinate with payers and trading partners to resolve issues.

The role requires at least 2 years in Healthcare EDI or billing, strong analytical and communication skills, and willingness to work in a consultancy contract (minimum 6 months). A Work from Home option is available, with a night shift differential.

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.

Responsibilities

• Submit medical claims to proper clearinghouse for payer review and payment.
• Process and monitor claim reports and electronic documents.
• Log and track submission and rejection information.
• Obtain edit reports and repair claims for re-submission timely.
• Cooperate with clearinghouses and trading partners to resolve EDI issues.

Skills

EDI processes

Claim submissions

Clearinghouses

Rejection management

Data analysis

Tools

EHR/EMR systems

Billing software

Job description

Job Description:

Salary: PHP 25,000 - PHP 35,000/ 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
• Open to consultancy contract minimum of 6 months

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