Medical Claims

RESPONSIBILITIESProcess new claims or modify existing claims according to the appropriate and applicable actionAnalyze claims to determine appropriate action to approve or deny a claim for paymentDetermine accurate payment criteria for clearing pending claims based on defined policies and proceduresResearch claims edits to determine appropriate benefit...

JOB PURPOSE:Responsible for analyzing, adjudicating, auditing and processing of claims (In-Patient, Out-Patient Hospital Bills and Professional Fees) according to set medical guidelines, policies within the agreed SLAs (Service Level of Agreements) Graduate of Bachelor of Science in Nursing or any related medical course.Above average communication and...

This function is responsible for Collections for Healthcare unpaid claims. This positions in this function interact with customers gathering support data to ensure invoice accuracy and also work through specific claims discrepancies. Provide input to policies, systems, methods, and procedures for the effective management and control of the premium collection...

Claims Associate role involves accurate logging, evaluation, and processing of claims, with a focus on sound business judgement and adherence to corporate policies and procedures. Job Description The Claims Associate is responsible for: Accurate logging of received claims from partner providers and/or clients Evaluation and prompt processing of...

Interviews, evaluates and classifies patients. Conducts social case management/social work intervention to patients referred with social, emotional or environmental problems affecting their medical situation; also those patients who are considered abandoned, neglected and victim of different types of abuse.Helps patient adjust to his environment conditions...

Medical Biller role requires processing claims for pediatrics clinics in USA, ensuring timely payment, denial investigation, and A/R recovery. Responsibilities: Posting payments and downloading ERA/EOB Investigating and appealing denied claims, correcting and resubmitting as needed Performing A/R recovery and collection Verifying patient...

This function is responsible for processing medical billing. This positions in this function interact with customers gathering support data to ensure invoice accuracy and also work through specific claims discrepancies. Provide input to policies, systems, methods, and procedures for the effective management and control of the premium collection function....

Be a part of our fast-growing team and unchain all the possibilitiesWhat is your mission?We are looking for a Medical Billing Specialist to manage accurate billing data, verify U.S. health insurance eligibility, submit claims with proper codes, and resolve denials or rejections. The role includes handling billing inquiries, posting payments, and ensuring...

Job Summary: Healthcare Claims Representative responsible for collections, account follow-up, billing, and allowance posting for assigned accounts. The Healthcare Claims Representative is responsible for collections, account follow-up, billing, and allowance posting for the accounts assigned to them. They will follow up with payers to ensure timely...

JOB QUALIFICATIONSAt least Senior Highschool GraduateWith minimum 12 months experience of Healthcare Accounts Receivable/ Billing Experience in a BPO setting or environment (Claims payments processing, claims status and tracking, Medical Billing, AR follow-ups, Denials and Appeals-outbound healthcare providers)Experienced on medical billing/AR...

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 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...

JOB DESCRIPTIONA Medical Secretary plays a vital role in a healthcare environment, keeping everything running smoothly while ensuring patients receive the care they need.Your job duties may include organizational tasks like checking in patients, securing referral authorizations, and updating patient information. You may also be responsible for managing...

Job DescriptionProvide 24/7 quality customer service globally for all clients and members. Close coordination with providers for claims evaluation and case management.Front line representative.Claims adjudication based on the procedure and medical plan coverage.Handle calls from clients, members, and providers.Establish a good rapport and assist members with...

A Fine Line Between Care and Collections: Achieve Work-Life Fulfillment in HealthcareBalance isn't just about numbers—it's about finding harmony in life and work. As a Medical Billing and Collection Specialist, you'll play a crucial role in the healthcare industry by ensuring smooth, accurate billing processes, contributing to the financial health of...

•Reviewed inpatient medical records and assigned accurate ICD-10-CM and PCS codes for diagnoses and procedures• Assigned and sequenced codes accurately based on medical record documentation.• Assigned POA indicators correctly.• Thorough understanding and application of medical necessity, DRGs, APGs, and APRs for processing claims• Adhered to coding...

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...

Participates in strategy development meetings. Work with the Chief Medical Officer (CMO) and Deputy CMO in developing and implementing innovative procedures, regulations, and programs to improve efficiency, quality, and customer service of the Medical and Provider Services Division. Acts as co-lead in dealing with provider groups for all medical practice...

Qualifications:Doctor of Medicine Computer literate (MSWord, Excel, Access) Good written & oral communication skillsAble to work independently with minimal supervision and exercise good judgmentExcellent people skillsHighly motivatedBackground in HMO setting / medical liaison experience preferred Job Summary:a. Do utilization rounds of admitted patients with...

Collaborate with healthcare providers and members to promote quality member outcomes, optimize benefits, and resource utilization. Collaborate with medical directors to interpret appropriateness of care and accurate claims payment. Manage appeals for services denied. Key responsibilities include: Conduct pre-certification, continued stay review, care...