EDI Specialist, Healthcare

Vector Outsourcing Solutions Philippines

EDI Specialist managing healthcare claims processing and submission to clearinghouses. Collaborating with healthcare partners to ensure EDI processes are efficient and accurate.

Posted 6/26/2026full-timeRemote • 🇵🇭 PhilippinesJuniorMid-Level💰 ₱25,000 - ₱28,000 per monthWebsite

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Healthcare EDIMedical BillingClaims ProcessingEDI processesClaim submissionsRejection managementEHR systemsEMR systemsBilling softwareData analysis

Soft Skills

Analytical skillsProblem-solving skillsOrganizational skillsCommunication skillsCoordination skillsDetail-orientedAbility to work in fast-paced environment