[Hiring] EDI Specialist @Vector Outsourcing Solutions Phils. Inc.

Role 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, testing, and ensuring 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 resolves 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.

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.

Benefits

• Maternity & Paternity Leave.
• Medical / Health Insurance.
• Paid Holidays.
• Paid Vacation Leave.
• Paid Sick Leave.
• Work from Home.
• Equipment/company computer is provided.
• Php 1,000 De Minimis.
• Php 1,000 monthly bonus upon regularization.
• HMO upon regularization.