EDI Claims Specialist: Resolve Rejections Across Payers

Pure Infusion; Sandy (UT); On-site; USD 34,000 - 55,000; Full time

Benefits offered by this job

401(k) Matching

Health, Vision, and Dental Insurance

Paid time off

Community service day

Job summary

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.

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.

Skills

EDI

Healthcare Billing

Communication

HIPAA Compliance

Tools

AdvancedMD

Waystar

Job description

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.