Claims Center and EDI Specialist

Clean claims don't happen by accident. Behind every payment is a file that transmitted correctly, matched the right payer, and got through the clearinghouse without a hitch. We're looking for an EDI Claim Specialist to own that process for Pure Infusion.

This isn't a role where you just watch a queue. You'll be the central point of contact for EDI across AdvancedMD, Waystar, and our payers, and the person who figures out why a file failed and what it takes to fix it for good.

You'll work across multiple states and payers, partnering with billing, coding, credentialing, and IT to trace each rejection back to its true root cause, whether that's an enrollment gap, a mapping error, or a payer policy change.

If you like detective work that makes the whole revenue cycle run smoother, this role gives you that every day.

The Claims Specialist is responsible for reviewing, processing, submitting, and following up on healthcare insurance claims to ensure accurate and timely reimbursement for services rendered. This position works to resolve claim rejections, denials, payment discrepancies, and outstanding accounts receivable while maintaining compliance with insurance guidelines, company policies, and HIPAA regulations.

• Submit electronic and paper claims to insurance companies within established timely filing limits.
• Investigate and resolve rejected claim center claims.
• Identify recurring denial trends and communicate issues to the appropriate team members or management.
• Collaborate with billing and intake teams, and other revenue cycle departments to resolve claim-related issues.
• Maintain patient confidentiality and comply with HIPAA requirements and applicable insurance regulations.
• Meet established productivity, quality, accuracy, and turnaround-time goals.
• Perform additional duties as assigned by the supervisor or management team.

We are looking for someone who is technical, persistent, and comfortable working through problems that span systems, payers, and teams. Ideal candidates will:

Manage payer-specific EDI setup and escalations from start to finish.

Collaborate well across RCM and credentialing teams

Stay organized while tracking multiple enrollments, payers, and transmission issues at once.

2+ years of experience with EDI in a healthcare billing or RCM environment.

Strong medical billing background, with working command of CPT/HCPCS and J-codes, ICD-10, modifiers, units/NDC, and NCCI/MUE edits sufficient to read a 277CA or scrubber edit and identify the underlying coding or payer-policy cause of a rejection.

Proven ability to manage payer-specific EDI setup and escalations.

Ability to ensure compliance with HIPAA EDI standards and internal RCM protocols.

Excellent written and verbal communication, especially when working with payer tech support.

Ability to meet U.S. employment and eligibility requirements.

Hands-on experience with AdvancedMD and Waystar clearinghouse systems.

Working knowledge of claims workflows in infusion services or specialty clinics.

Ability to work independently and collaboratively as part of a team

Strong attention to detail, organization, and analytical problem-solving skills.

Proficiency in computer systems, data entry, Microsoft Office and Electronic billing platforms.

At Pure Infusion, you will find a role where your work matters in a direct and personal way. You will be part of a team that is building a better healthcare experience for patients, providers, and employees. If this resonates with you, we would love to meet you.

Thank you for considering a career with Pure Infusion. We look forward to the opportunity to work together.