AR Specialist – Claims

4 days ago

Cebu City, Philippines Eli Global Phil. Resource Operation CTR I Full time

About the Role We’re seeking a meticulous and motivated Accounts Receivable Specialist – Claims to support timely and accurate reimbursement for healthcare services. This role is essential to maintaining the organization’s financial stability by managing outstanding claims, resolving denials, and minimizing aged receivables. The ideal candidate brings practical experience in medical billing, payer policies, and effective claim resolution techniques. Key Responsibilities Monitor and follow up on pending or unpaid insurance claims across government and commercial payers. Research and resolve denied, underpaid, or incorrectly processed claims using payer portals, phone communication, and written correspondence. Prepare and submit corrected claims, appeals, and required documentation to expedite payment. Record all claim activity accurately, keeping detailed and current account notes. Review aging reports to identify priority accounts and focus on high-value or time-sensitive claims. Collaborate with internal departments—such as coding and clinical teams—to correct discrepancies and obtain necessary information. Adhere to HIPAA guidelines and comply with all payer and billing regulations. Handle payer and patient inquiries courteously and within established response times. Assist with month-end reporting and reconciliation processes related to accounts receivable. Qualifications 1–2 years of experience in accounts receivable, healthcare billing, or medical claims management. Solid knowledge of the insurance claim process, CPT/ICD-10 coding, and payer policies (Medicare, Medicaid, and commercial insurers). Experience with EMR and billing systems such as NextGen, Claim Source, Experian, Noridian, Availity, Insurance Portals, or Zelis. Exceptional organizational, analytical, and communication abilities. Proven capacity to manage multiple priorities, work independently, and perform effectively in a fast-paced environment. #J-18808-Ljbffr

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