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Medical Claims Analysts

1 month ago

Manila, National Capital Region, Philippines MED-METRIX INTERNATIONAL PH-I, INC. Full time

Medical Claims Representative Job Summary: Responsible for collections, account follow-up, billing, and allowance posting for assigned accounts.

The Medical Claims Representative is a key role in our organization, responsible for ensuring timely resolution of outstanding claims and maintaining daily productivity/quality standards. The ideal candidate will have a strong understanding of medical billing and AR collections, with experience in calling insurance payers to verify claim status and payment disputes.

  • Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or websites.
  • Meet and maintain daily productivity/quality standards established in departmental policies.
  • Use workflow system, client host system and other tools available to collect payments and resolve accounts.
  • Adhere to policies and procedures established for the client/team.
  • Knowledge of timely filing deadlines for each designated payer.
  • Perform research regarding payer specific billing guidelines as needed.
  • Analyze, identify and resolve issues causing payer payment delays.
  • Analyze, identify and trend claims issues to proactively reduce denials.
  • Communicate to management any issues and/or trends identified.
  • Initiate appeals when necessary.
  • Identify and correct medical billing errors.
  • Send appropriate appeals, accurate requesting information, supporting documentation, and effective communication to complete recovery process.
  • Understand under or over payments and credit balance processes.
  • Assist with special A/R projects as needed.
  • Act cooperatively and courteously with patients, visitors, co-workers, management and clients.
  • Use, protect and disclose patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
  • Work independently from assigned work queues.
  • Maintain confidentiality at all times.
  • Maintain a professional attitude.

Requirements:

  • Completed at least High School education.
  • With minimum 1 year of Healthcare Account Receivable/Collections in a BPO setting or environment.
  • Experienced on medical billing/AR Collections.
  • Background in calling insurance (Payer) to verify claim status and payment dispute.
  • Able to work during US hours.

Working Conditions:

  • Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
  • Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.

Benefits:

  • 8-Hour Shifts, Fixed Weekends Off
  • Day 1 HMO with 2 of your dependents covered for FREE
  • Medical Cash Allowance
  • Rice Allowance
  • Clothing Allowance
  • Free Lunch Daily
  • Paid Time Off
  • Training and Staff Development
  • Employee Engagement Activities
  • Opportunities for Internal Mobility