EDI Specialist, Healthcare

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Vector Outsourcing Solutions Philippines

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2014

🤝 B2B

🛍️ eCommerce

⚕️ Healthcare Insurance

B2B • eCommerce • Healthcare Insurance

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

• 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

🎯 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 • 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

🏖️ Benefits

• Maternity & Paternity Leave • Medical / Health Insurance • Paid Holidays • Paid Vacation Leave • Paid Sick Leave • Equipment/ company computer is provided • Php 1,000 De Minimis • Php 1,000 monthly bonus upon regularization • HMO upon regularization