EDI Consultant, Healthcare

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

📋 Description

• Submit medical claims to the appropriate clearinghouse for review and payment decisions by insurance payers.

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

• Log and monitor submission and rejection data.

• Obtain edit reports, rectify claims for resubmission, and promptly test repairs.

• Confirm that claims are dispatched to the correct clearinghouse.

• Support EDI claim submissions and maintain accurate logs.

• Keep abreast of policies, regulations, and changes from payers and clearinghouses.

• Coordinate and test EDI implementations with both new EDI partners and existing clearinghouses.

• Resolve errors related to rejections and submissions with clearinghouses and trading partners.

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

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

• Review and coordinate modifications to EDI services, including new payer IDs and claim edits.

• Monitor daily EDI operations, analyze complex datasets, troubleshoot issues, and address them swiftly.

• Facilitate the onboarding process for new client EDI accounts.

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

• Maintain data integrity for uploaded files and batches.

• Coordinate resolution processes with teams, leadership, and account managers.

• Escalate unresolved EDI issues to the Manager/Credentialing team.

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

• Conduct random inquiries into claim statuses.

• Reconcile claim files between received-charge batches and EDI-submitted batches.

• Analyze rejection trends that necessitate corrections on the billing side.

⛳️ Requirements

• Minimum of 2 years of 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 procedures.

• Preferred experience with EHR/EMR systems and billing software.

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

• Excellent communication and coordination skills.

• Detail-oriented with the capability to thrive 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 options.

• Equipment/company computer provided.

• Night shift differential pay.

• Php 1,000 De Minimis.

• Php 1,000 monthly bonus upon regularization.

• HMO benefits upon regularization.