Claims Center and EDI Specialist

Pure Infusion; Sandy (UT); Sur place; USD 34 000 - 55 000; Plein temps

Avantages offerts par ce poste

401(k) Matching

Health, Vision, and Dental Insurance

Paid time off

Community service day

Résumé du poste

Pure Infusion is seeking an EDI Claim Specialist to own the claims lifecycle, ensuring accurate and timely reimbursements through proactive error investigation and cross-team collaboration.

You will manage payer-specific EDI setups, work with AdvancedMD and Waystar, and drive root-cause analysis for rejections while complying with HIPAA and internal policies. This role blends problem solving with operations to strengthen the revenue cycle.

Qualifications

• 2+ years of experience with EDI in a healthcare billing or RCM environment.
• Strong medical billing background with CPT/HCPCS and ICD-10, modifiers, units/NDC, and NCCI/MUE edits sufficient to read a 277CA or scrubber edit and identify the underlying coding or payer-policy cause of a rejection.
• Proven ability to manage payer-specific EDI setup and escalations.
• Ability to ensure compliance with HIPAA EDI standards and internal RCM protocols.
• Excellent written and verbal communication, especially when working with payer tech support.
• Ability to meet U.S. employment and eligibility requirements.

Responsabilités

• Submit electronic and paper claims to insurance companies within established timely filing limits.
• Investigate and resolve rejected claim center claims.
• Identify recurring denial trends and communicate issues to the appropriate team members or management.
• Collaborate with billing and intake teams, and other revenue cycle departments to resolve claim-related issues.
• Maintain patient confidentiality and comply with HIPAA requirements and applicable insurance regulations.
• Meet established productivity, quality, accuracy, and turnaround-time goals.
• Perform additional duties as assigned by the supervisor or management team.

Connaissances

EDI

Healthcare Billing

Communication

HIPAA Compliance

Outils

AdvancedMD

Waystar

Description du poste

Clean claims don't happen by accident. Behind every payment is a file that transmitted correctly, matched the right payer, and got through the clearinghouse without a hitch. We're looking for an EDI Claim Specialist to own that process for Pure Infusion.

Why This Role Feels Different

This isn't a role where you just watch a queue. You'll be the central point of contact for EDI across AdvancedMD, Waystar, and our payers, and the person who figures out why a file failed and what it takes to fix it for good.

You'll work across multiple states and payers, partnering with billing, coding, credentialing, and IT to trace each rejection back to its true root cause, whether that's an enrollment gap, a mapping error, or a payer policy change.

If you like detective work that makes the whole revenue cycle run smoother, this role gives you that every day.

The Job

The Claims Specialist is responsible for reviewing, processing, submitting, and following up on healthcare insurance claims to ensure accurate and timely reimbursement for services rendered. This position works to resolve claim rejections, denials, payment discrepancies, and outstanding accounts receivable while maintaining compliance with insurance guidelines, company policies, and HIPAA regulations.

Key Responsibilities

• Submit electronic and paper claims to insurance companies within established timely filing limits.
• Investigate and resolve rejected claim center claims.
• Identify recurring denial trends and communicate issues to the appropriate team members or management.
• Collaborate with billing and intake teams, and other revenue cycle departments to resolve claim-related issues.
• Maintain patient confidentiality and comply with HIPAA requirements and applicable insurance regulations.
• Meet established productivity, quality, accuracy, and turnaround-time goals.
• Perform additional duties as assigned by the supervisor or management team.

The Ideal Candidate

We are looking for someone who is technical, persistent, and comfortable working through problems that span systems, payers, and teams. Ideal candidates will:

Manage payer-specific EDI setup and escalations from start to finish.

Collaborate well across RCM and credentialing teams

Stay organized while tracking multiple enrollments, payers, and transmission issues at once.

Required Qualifications

2+ years of experience with EDI in a healthcare billing or RCM environment.

Strong medical billing background, with working command of CPT/HCPCS and J-codes, ICD-10, modifiers, units/NDC, and NCCI/MUE edits sufficient to read a 277CA or scrubber edit and identify the underlying coding or payer-policy cause of a rejection.

Proven ability to manage payer-specific EDI setup and escalations.

Ability to ensure compliance with HIPAA EDI standards and internal RCM protocols.

Excellent written and verbal communication, especially when working with payer tech support.

Ability to meet U.S. employment and eligibility requirements.

Preferred Qualifications

Hands-on experience with AdvancedMD and Waystar clearinghouse systems.

Working knowledge of claims workflows in infusion services or specialty clinics.

Ability to work independently and collaboratively as part of a team

Strong attention to detail, organization, and analytical problem-solving skills.

Proficiency in computer systems, data entry, Microsoft Office and Electronic billing platforms.

Why Join Pure Infusion?

At Pure Infusion, you will find a role where your work matters in a direct and personal way. You will be part of a team that is building a better healthcare experience for patients, providers, and employees. If this resonates with you, we would love to meet you.

Thank you for considering a career with Pure Infusion. We look forward to the opportunity to work together.

About Pure Infusion

Pure Infusion is a fast-growing healthcare company and a leader in chronic-condition infusion therapy. We deliver a personalized, private, and meaningful infusion experience for patients who often need ongoing care and consistency. Pure Infusion has been recognized as one of Utah's fastest-growing companies, and we believe that growth is a reflection of our people, purpose, values, and patient-first culture.

Our patients are referred by specialty physicians for biologic and other infusion therapies, often related to autoimmune disorders or primary deficiencies. These patients need more than an appointment. They need a place that feels calm, professional, comfortable, and human.

Our Core Values

We live by four core values that define our culture and guide our hiring:

People-Obsessed

We care deeply about patients, teammates, referring providers, and every person who interacts with Pure Infusion.

Relentlessly Improving

We look for ways to make every visit, every process, and every interaction better than it was yesterday.

We are willing to challenge old healthcare assumptions and build a better model for patients and teams.

Grateful

We serve with humility, appreciate the people around us, and believe gratitude should turn into action.

Schedule and Benefits Snapshot

Our regular hours are generally Monday through Friday, 8 a.m. to 5 p.m., with most weekends and holidays off. In addition to a competitive hourly rate, we offer:

• Competitive hourly rate
• 401(k) Matching
• Health, Vision, and Dental Insurance
• Over 20 days of paid time off annually
• One paid community service day each year to give back in a way that matters to you, either with your clinic, with the corporate team, or through a community cause you personally care about