EDI Consultant, Healthcare

This is a fully remote position, open to applicants in Philippines.

📋 Description

• Submit medical claims to the appropriate clearinghouse for insurance payer evaluation and payment determinations.

• Process and track claim reports along with electronic and paper claim transactions.

• Record and monitor submission and rejection data.

• Acquire edit reports and amend claims for resubmission; test and ensure timely corrections.

• Confirm claims are dispatched to the correct clearinghouse.

• Provide backup for EDI claim submissions and related information.

• Stay informed on policies, regulations, and changes from payers and clearinghouses.

• Coordinate and test EDI implementations with new EDI partners as well as current clearinghouses.

• Address EDI issues such as rejection and submission errors with clearinghouses and trading partners.

• Collaborate with payers, clearinghouses, and trading partners to sustain EDI processes.

• Test, implement, and document procedures for new accounts or billing software.

• Review and coordinate service modifications, including new payer IDs and claim edits.

• Monitor daily EDI performance, analyze complex datasets, troubleshoot issues, and resolve them promptly.

• Facilitate the onboarding process for new client EDI accounts.

• Ensure ECPP, QRSP, and HPNA interfaces function as intended.

• Maintain data integrity for uploaded files and batches.

• Oversee resolution processes and collaborate with teams, leaders, and account managers.

• Escalate unresolved EDI issues to the Manager/Credentialing.

• Manage the daily send/receive files and address rejected claims.

• Conduct random claim status inquiries.

• Reconcile claim files between received charges and EDI submissions.

• Analyze rejections to identify error patterns that necessitate billing corrections.

⛳️ Requirements

• Minimum of 2 years’ experience in Healthcare EDI, Medical Billing, or Claims Processing.

• Understanding of EDI processes, claim submissions, clearinghouses, and rejection management.

• Familiarity with healthcare insurance payers, claim edits, and reimbursement protocols.

• Experience with EHR/EMR systems and billing software is preferred.

• Strong analytical, problem-solving, and organizational abilities.

• Excellent communication and coordination capabilities.

• Detail-oriented and capable of thriving in a fast-paced environment.

• Willingness to engage in a consultancy contract for a minimum of 6 months.

🏝️ Benefits

• Maternity & Paternity Leave.

• Government Contributions (SSS, Pag-ibig, Philhealth).

• 13th Month Pay.

• Paid Holidays.

• Bereavement Leave.

• Paid Vacation Leave.

• Paid Sick Leave.

• Work from Home option.

• Equipment/company computer provided.

• Night shift differential pay.

• Php 1,000 De Minimis.

• Php 1,000 monthly bonus upon regularization.

• HMO coverage upon regularization.