AR Complex Clinical Denials Specialist

2 days ago


Pasig City, Philippines Visaya KPO Full time

Job descriptionEssential Duties & ResponsibilitiesVerify/obtain eligibility and/or authorization utilizing payer web sites, client eligibility systems or via phone with the insurance carrier/providersUpdate patient demographics/insurance information in appropriate systemsResearch/ Status unpaid or denied claimsMonitor claims for missing information, authorization, and control numbers (ICN//DCN)Research EOBs for payments or adjustments to resolve claimContacts payers via phone or written correspondence to secure payment of claims; reconsideration and appeal submission.Access client systems for payment, patient, claim and data infoFollows guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systemsSecure needed medical documentation required or requested by third party insurance carriersMaintain and respect the confidentiality of patient information in accordance with insurance collection guidelines and corporate policy and procedurePerform other related duties as requiredMinimum Requirements & Competencies:3+ years of medical collections, denials and appeals experienceMust have atleast 6 months of EPIC tool experienceExperience with all but not limited to the following denials- DRG downgrades, level of care, coding, medical necessityIntermediate knowledge of ICD-10, CPT, HCPCS and NCCIIntermediate knowledge of third-party billing guidelinesIntermediate knowledge of billing claim forms (UB04/1500)Intermediate knowledge of payor contracts- commercial and governmentIntermediate Working Knowledge of Microsoft Word and ExcelIntermediate knowledge of health information systems (i.e. EMR, Claim Scrubbers, Patient Accounting Systems, etc.)Intermediate of DDE Medicare claim systemIntermediate Knowledge of government rules and regulationsMust be willing to work onsite in Ortigas, Pasig City.Enjoy the ff. Perks and Benefits:15% Night DifferentialHMO Benefits after 30 days + Add Up to 2 DependentsRetirement Benefits24 Leave Credits per year, Convertible to CashWholistic Employee Wellness ProgramJob Type: Full-time



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