Healthcare EDI Specialist | Healthcare | Work From Home
Vector Outsourcing Solutions Phils., Inc.
- Mandaluyong, Philippines8th Floor Unit 804, 530, Shaw Blvd, Wack-Wack Greenhills, Mandaluyong, Metro Manila, PhilippinesMandaluyongMetro ManilaPhilippinesPhilippinesTELECOMMUTE
- ₱25,000.00 - ₱30,000.00 / monthPHP250003000025000MONTH
- Full timeFULL_TIME
Posted 4 days ago and deadline of application is on 6 Jul
Recruiter was hiring 17 hours ago
2026-05-08T07:09:16.198854+00:002026-07-06T16:00:00+00:00Job 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
Perks and Benefits
Paid Vacation Leave
Paid Sick Leave
Work from Home
Maternity & Paternity Leave
Paid Holidays
Other
- Equipment/ company computer is provided
- Php 1,000 Rice Allowance
- Php 1,000 monthly bonus upon regularization
- HMO upon regularization
Jobs Summary
- Job Level
- Entry Level / Junior, Apprentice
- Job Category
- Health and Medical
- Educational Requirement
- Bachelor's degree graduate
- Recruiter response to application
- Sometimes
- Office Address
- 530, Shaw Blvd, Wack-Wack Greenhills
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About Vector Outsourcing Solutions Phils., Inc.
We are fast growing US based healthcare BPO supporting medical groups, dental groups, diagnostic laboratories, urgent care centers and other ancillary health care providers. Join us now and become one of our leaders as we continue to grow.
Vision:
To improve healthcare delivery by placing the needs of both providers and patients at the forefront and delivering exceptional customer service
Mission:
To provide world class customer service, that drives efficiency and progress within the healthcare system, by working together in a culture of continuous improvement and innovation
Values:
Transparency
Honesty
Accountability
Trust
Responsibility
Efficiency
Adaptability
Innovation
Respect