Healthcare EDI Specialist | Healthcare | Work From Home
Vector Outsourcing Solutions Phils., Inc. Mandaluyong
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.
- 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
Vector Outsourcing SolutionsMandaluyong
information.
• Able to work from home with reliable internet and a backup connection.
Others:
• Equipment/ company computer is provided
• Work from Home...
Vector Outsourcing Solutions Phils., Inc.Mandaluyong
speed of 40 WPM or faster, are required.
• Must demonstrate the ability to work with and protect confidential information.
• Able to work from home with reliable internet and a backup connection....
Private AdvertiserPateros, 6 km from Mandaluyong
Position: Part-Time Virtual Sales/Insurance Agent
Location: Remote / Work From Home / Flexible Shift
Schedule: Flexible, Part-Time
Compensation: Commission-based + Incentives
Job Description:
• Conduct virtual consultations with potential clients...