US Healthcare Claims Specialist

Responsibilities:Review claims or modify existing claims according to the appropriate and applicable actionAnalyze claims to determine appropriate action to approve or deny action done by the agentDetermine if accurate payment criteria for clearing pending claims based on defined policies and procedures were appliedResearch claims edits to determine if...

Healthcare Account Receivable/Collections Specialist Job Title: Healthcare Account Receivable/Collections Specialist Company: Optum Join our team at Optum, a leading health care company, and be part of a mission to create a healthier world. Job Summary: We are seeking a highly skilled Healthcare Account Receivable/Collections Specialist to join our...

Responsibilities:Review claims or modify existing claims according to the appropriate and applicable actionAnalyze claims to determine appropriate action to approve or deny action done by the agentDetermine if accurate payment criteria for clearing pending claims based on defined policies and procedures were appliedResearch claims edits to determine if...

Job Description:Account Receivable Caller (US Healthcare) Roles and Responsibilities: Review providers claim that have not been paid by the insurance companiesFollow-up with Insurance companies to understand the status of the claim - Initiate telephone calls or verify through payer websites or otherwise request the required information from insurance...

Qualification For Outpatient US Healthcare (Pediatrics)Review medical charts electronically; assign accurate codes for diagnoses and procedures, using ICD, CPT and HCPCS codes based on the documented information in the medical record.Ensures codes are accurately assigned and sequenced correctly according to medical coding rules and guidelines to prevent...

Company Overview:We are a company built on trust and loyalty. MBVA 24/7 started in 2018 and has continuously fostered skilled and talented Virtual Assistants for many clients. Our team of virtual assistants provides services all over the US, and we sure won’t be stopping there! Our main office is located in Arizona and Manila. We have a legion of virtual...

JOB DESCRIPTION:Identify and categorize various claims/policy related documents and process based on established document workflows.Prepares inbound correspondence for imaging to route for processing/final disposition.Monitors email boxes, inboxes and other systems to fulfill requested services.Process inbound checks related to claims/policy accounts.Prepare...

JOB QUALIFICATIONSCompleted at least 2 years in collegeWith minimum 12 months experience of Healthcare Account Receivable/Collections/Billing in a BPO setting or environment (claims payments processing, claims status and tracking, Medical Billing, AR Follow ups, Denials and Appeals-outbound healthcare providers)Familiarity with UB Claims and knowledge in...

Medical Prior Authorization-Insurance Verification SpecialistPosition Summary:The Prior Authorization Specialist plays a crucial role in the healthcare industry by ensuring that medical services, procedures, and medications are approved by insurance companies or third-party payers before they are rendered or prescribed. They work closely with healthcare...

Job Description:The Claims Non-Voice Specialist is responsible for ensuring the effective and efficient delivery of best customer experience in assisting member OP availment via non-voice request by following the benefit plan and supporting the cost management initiatives which will contribute to client retention.Job Qualifications:Graduate of any...

Shift Schedule: NightshiftWork Setup: Onsite Required Education:Graduate of BS Nursing or any Allied Medical courses Required Skill Sets:Oversees the operations of the billing department, encompassing medical coding, charge entry, claims submissions, payment posting, accounts receivable follow-up, and reimbursement management.Analyze billing and claims for...

Processes Non-Life insurance claims within the agreed service level standards.Reviews and evaluates completeness of documents for claims processing.Ensures timely submission of claim documents to insurers. Assists clients in filing third party claims to other insurance companies.Schedules meeting with insurers to discuss claims related issues as needed...

Role DescriptionThis is a full-time role as a Regulatory Affairs Specialist at Kusum Healthcare Private Limited located in Ortigas Center, Pasig. The Regulatory Affairs Specialist will ensure compliance with regulations and standards set by regulatory authorities, developing and maintaining regulatory documentation, coordinating regulatory submissions, and...

This is a remote position. Role Name: Virtual Assistant - Medical Billing Specialist Schedule: Part-time, 4 hours per day (11:00 AM to 3:00 PM AWST), Monday to Friday Client Timezone: AWST (Australian Western Standard Time) Client OverviewJoin a cutting-edge surgical assisting business at the forefront of Australia’s healthcare sector. This dynamic...

Medical Claims Representative Job Title: Medical Claims Representative Company: [Company Name] The Medical Claims Representative plays a vital role in ensuring the smooth operation of our medical billing and collections process. As a key member of our team, you will be responsible for collecting payments, resolving outstanding claims, and maintaining...

JOB PURPOSE:The Reconciliation Specialist is responsible for facilitating all reconciliation requests from accredited providers and address/resolves the concerns raised by the providers regarding unsettled claims reflected in the facility’s records.  This role is also responsible for addressing reconciliation issues with providers to prevent IHC...

Join Access Healthcare Manila as a Inpatient DRG Nurse Auditor. We are seeking talented individuals to join our team and help drive our success. Apply now and take the next step in your career today. We will provide free training on the client’s medical billing software to perform this role.Tasks:Conduct initial audit reviews to validate billed diagnoses...

ResponsibilitiesProcessing of out-patient and in-patient utilizationChecking the completeness of supporting documentsEncoding in the Enhanced Membership Monitoring System (EMMS) of details of utilization such as diagnosis, amount, procedure done, hospital bills, and professional feesProcessing of members' utilization reimbursement such as maternity...

Job Description: This role involves:-Customer Support: Providing exceptional customer service by handling inquiries, resolving issues, and offering solutions to clients’ problems.-Member Helpdesk Support: Assisting members with their healthcare-related questions and concerns, ensuring they receive accurate and timely information.-Case Management: Managing...

Stand as the Pillar of Global Opportunity: Ensure Every Claim Counts in HealthcareThe heart of healthcare beats through precision and dedication. As a Claims Status Representative, you’ll be a crucial player in this rhythm, handling essential tasks such as managing 0-60 days aging spreadsheets and addressing denied claims. Your role will also involve...