EDI Consultant, Healthcare

🔥 0 minutes ago

🇵🇭 Philippines – Remote

💵 ₱25k - ₱35k / month

⏳ Contract/Temporary

🟢 Junior

🟡 Mid-level

💼 Consultant

🚫👨‍🎓 No degree required

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Vector Outsourcing Solutions Philippines

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2014

🏥 Healthcare

📦 Logistics

📣 Marketing

Healthcare • Logistics • Marketing

Vector Outsourcing Solutions Philippines is a leading business process outsourcing (BPO) provider dedicated to enhancing the operational efficiency of its clients. With over 20 years of experience and a workforce of more than 300 employees, the company excels in delivering tailored outsourcing solutions, particularly to the healthcare sector, including services like medical billing and revenue cycle management. Vector Outsourcing focuses on optimizing client operations through technology and analytics, ensuring quality customer service, and reducing operational costs to foster growth for the businesses they support.

📋 Description

• Submit medical claims to the proper clearinghouse for insurance payer review and payment decisions • Process and monitor claim reports and electronic and paper claim transactions • Log and track submission and rejection information • Obtain edit reports, repair claims for resubmission, and test repairs promptly • Verify claims are sent to the proper clearinghouse • Back up EDI claim submissions and log information • Keep policies, regulations, and payer/clearinghouse changes updated • Coordinate and test EDI implementations with new EDI partners and current clearinghouses • Resolve rejection and submission errors with clearinghouses and trading partners • Collaborate with payers, clearinghouses, and trading partners to maintain EDI processes • Test, implement, and document processes for new accounts and billing software • Review and coordinate EDI service modifications, including new payer IDs and claim edits • Monitor daily EDI performance, analyze complex datasets, troubleshoot issues, and resolve them promptly • Facilitate onboarding of new client EDI accounts • Ensure ECPP, QRSP, and HPNA interfaces perform as designed • Ensure data integrity for uploaded files and batches • Coordinate resolution processes with teams, leaders, and account managers • Escalate unresolved EDI issues to the Manager/Credentialing team • Manage send/receive files and work rejected claims daily • Perform random claim status inquiries • Reconcile claim files between received-charge batches and EDI-submitted batches • Analyze rejection patterns requiring correction on the billing end

🎯 Requirements

• At least 2 years of experience in Healthcare EDI, Medical Billing, or Claims Processing • Knowledge of EDI processes, claim submissions, clearinghouses, and rejection management • Familiarity 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 a consultancy contract minimum of 6 months

🏖️ 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 • Equipment/company computer is provided • Night shift differential pay • Php 1,000 De Minimis • Php 1,000 monthly bonus upon regularization • HMO upon regularization