EDI Consultant (Healthcare) | Work From Home

Salary: PHP 25,000 - PHP 35,000/ month Job 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, test, and ensure 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 resolve 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. Minimum 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 - Open to consultancy contract minimum of 6 months Perks and Benefits: - Maternity & Paternity Leave - Government Contribution (SSS, Pag-ibig, Philhealth) - 13th Month Pay - Paid Holidays - Bereavement Leave - Paid Vacation Leave - Paid Sick Leave - Work from Home Others: - Equipment/ company computer is provided - Night shift differential pay - Php 1,000 Rice Allowance - Php 1,000 monthly bonus upon regularization - HMO upon regularization Originally posted on Himalayas