Job Description

Position Summary

We are seeking a detail-oriented and highly organized Electronic Data Interchange (EDI) Claims Filing Specialist to join our healthcare revenue cycle team. This individual will be responsible for ensuring accurate and timely submission of hospital claims to payors through electronic and manual filing methods while maintaining compliance with filing requirements and supporting documentation standards.

The ideal candidate thrives in a fast-paced healthcare environment, demonstrates strong problem-solving abilities, and is committed to accuracy, productivity, and exceptional internal customer service.

Reports To: EDI Manager

Supervisory Responsibilities: None

Key Responsibilities

• Review, prepare, and submit claims in accordance with departmental policies and payor requirements through electronic and manual filing methods.
• Identify, research, and resolve billing, clearinghouse, and claim submission errors to ensure timely and accurate claim filing.
• Investigate and address payor-specific filing requirements, including gathering additional documentation and updating filing methods as necessary.
• Perform daily reconciliations to ensure all claims are accurately accounted for across billing systems, work queues, and clearinghouse platforms.
• Review incoming correspondence and take appropriate action to resolve claim-related issues.
• Maintain departmental productivity and quality standards while meeting established performance metrics.
• Develop and maintain a working knowledge of departmental workflows, systems, and claim filing tools.
• Ensure compliance with organizational policies, procedures, regulatory requirements, and company standards of conduct.
• Collaborate effectively with internal teams and external stakeholders to support efficient claims processing and issue resolution.
• Perform additional duties and special projects as assigned.

Qualifications & Skills

Core Competencies

Organization & Time Management

• Ability to organize, prioritize, and accurately manage multiple tasks within tight deadlines.
• Capable of working efficiently in a high-volume, fast-paced environment while maintaining attention to detail.
• Demonstrates adaptability and strong analytical/problem-solving skills.

Technical Skills

• Proficient in Microsoft Office Suite and other applicable systems and software.
• Ability to learn and navigate healthcare billing, clearinghouse, and workflow systems.

Communication Skills

• Strong verbal and written communication skills with attention to grammar, punctuation, and professionalism.
• Ability to communicate clearly and effectively across multiple departments and external partners.

Customer Service Orientation

• Builds strong working relationships through professionalism, trust, and consistent service excellence.
• Demonstrates a commitment to meeting and exceeding customer expectations.

Interpersonal Skills

• Works effectively both independently and collaboratively in a team-oriented environment.
• Maintains positive working relationships with employees, patients, payors, and external stakeholders.

Policies & Procedures

• Demonstrates understanding of organizational policies, procedures, workflows, and compliance requirements.

Preferred Experience

• Prior experience in hospital claims filing, medical billing, EDI processing, revenue cycle management, or healthcare claims administration strongly preferred.
• Experience with clearinghouse systems, claim reconciliation, payor filing requirements, and denial/error resolution preferred.