EDI Consultant, Healthcare

About the Role

In this position, you will serve as a key member of our healthcare team, acting as a liaison between clinical data and revenue cycle processes. You will be responsible for overseeing the electronic data interchange systems that facilitate essential communication between healthcare providers, insurance companies, and clearinghouses. By joining our team, you will focus on improving billing efficiency, resolving technical submission issues, and maintaining the accuracy and regulatory compliance of medical claims. This remote role operates in a high-speed environment where your technical expertise will drive client success. You will manage everyday EDI functions, analyze intricate data sets, and lead the integration of new accounts to ensure billing workflows and digital interfaces operate correctly.

Requirements

• You should have a minimum of two years of professional experience in medical billing, claims management, or Healthcare EDI.
• You must demonstrate a thorough knowledge of EDI processes, submission standards, clearinghouse functions, and methods for addressing rejected claims.
• You are expected to be familiar with insurance payer operations, claim validation rules, and various reimbursement workflows.
• It is highly preferred that you are proficient in using EMR or EHR platforms and medical billing applications.
• This position requires strong organizational, analytical, and problem-solving capabilities, as well as superior communication skills to work effectively across departments.
• You must possess a keen eye for detail to thrive in this high-volume workplace and commit to a contract duration of at least six months.

Responsibilities

• You will be responsible for transmitting medical claims to clearinghouses and tracking both electronic and paper-based transactions to guarantee payment precision.
• Your tasks involve documenting submission records, fixing and investigating rejected claims, and organizing testing phases for new EDI setups.
• You will track daily EDI metrics by examining complex data to find and rectify recurring error trends.
• You will also manage the onboarding process for new clients, oversee file exchanges, maintain data consistency across systems, and balance incoming charges against EDI submissions.
• You will keep current on evolving payer regulations and legal standards to maintain process compliance, while reporting difficult technical problems to management.

Benefits & Perks

• You will receive a company-issued computer for your home office.
• Leave benefits include paid sick, vacation, bereavement, and maternity or paternity leave.
• The package includes paid public holidays and mandatory government contributions, including Philhealth, Pag-ibig, and SSS.
• You will be entitled to a 13th-month salary, a night shift premium where applicable, and a monthly de minimis benefit of Php 1,000.
• Upon achieving regularized status, you will receive a Php 1,000 monthly bonus and access to health insurance via an HMO.