Medical Claims Specialist | 10k Sign-on Bonus | Onsite
4 weeks ago
Medical Claims Specialist | 10k Sign-on Bonus | Onsite - Ortigas Connext Pasig, National Capital Region, Philippines The Medical Claims Specialist is responsible for the timely submission of technical or professional medical claims to insurance companies. This role involves verifying patient and billing information, editing claims for compliance, resolving denials, and communicating with both payers and internal teams. Responsibilities Utilize various hospital/physician systems to verify patient, billing, and claim information for accuracy. Perform compliant primary/secondary, tertiary, and rebill billing functions across electronic, paper, and portal platforms. Edit claims to meet payer-specific compliance requirements (electronic and hardcopy). Respond timely to email and telephone messages as appropriate. Communicate claim issues to management, payers, system contacts, or escalated account owners. Participate in department training seminars and in-services to expand job knowledge. Serve and protect the hospital community by adhering to policies, procedures, and standards (federal, state, local, JCAHO). Support the billing department and hospital reputation by accepting ownership of tasks and delivering value through performance. Update patient demographics and insurance details in appropriate systems. Monitor claims for missing info, automation flags, or control numbers (ICN/DCN). Follow protocols for prioritization, deadlines, and notation accuracy. Secure needed documentation from payers or third-party sources. Maintain confidentiality of patient information in compliance with policy. Qualifications and Requirements Experience with claims management and rejection editing. Familiarity with patient accounting systems such as EPIC, Cerner, STAR, Meditech, CPSI, Invision, PBAR, Allscripts, or Paragon. Experience identifying billing errors, correcting and resubmitting claims, and resolving denials or underpayments. Familiarity with EOB, UB04, and 1500 billing forms. Knowledge of ICD-10, CPT, HCPCS, and NCCI coding. Ability to read, interpret, and apply payer contracts. Proficient in navigating healthcare information systems (EMR, Patient Accounting, Claim Scrubbers, etc.). Understanding of accounts receivable processes and third-party payer coordination. Ability to use Internet Explorer, Microsoft Outlook, Excel, and internal email/calendar tools. Exhibits a strong ability to work both independently and collaboratively within a team. Proven track record of meeting performance metrics and deadlines. Clear and coherent in both written and verbal communication skills with the ability to communicate effectively with payers and team members. Screening Criteria High school diploma or equivalent combination of education and work experience. Minimum of two (2) to four (4) years in claims management, claims processing, or claims resolutions, preferably in a hospital or payer setting. Must have stable employment history. Seniority level Not Applicable Employment type Full-time Job function Customer Service, Health Care Provider, and OtherIndustries: Hospitals and Health Care and Claims Adjusting, Actuarial Services #J-18808-Ljbffr
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Pasig, Philippines Connext Global Solutions Inc Full timeJob Summary The Medical Claims Specialist is responsible for the timely submission of technical or professional medical claims to insurance companies. This role involves verifying patient and billing information, editing claims for compliance, resolving denials, and communicating with both payers and internal teams. Responsibilities Utilize various...
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US Payroll Specialist with 10k Sign On Bonus
4 weeks ago
Pasig, Philippines Connext Full timeUS Payroll Specialist with 10k Sign On Bonus - Ortigas Connext Pasig, National Capital Region, Philippines Job Summary The Payroll Specialist is responsible for processing payroll accurately and on time, ensuring compliance with federal, state, and local regulations. This role requires attention to detail, strong organizational skills, and the ability to...
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Insurance Verification Specialist
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Pasig, National Capital Region, Philippines Connext Global Solutions Inc Full time ₱300,000 - ₱600,000 per yearConnext is a dedicated team of business process outsourcing experts and innovators, with experience in supporting world-class companies in Title and Escrow, Healthcare, Produce Distribution, Retail and Fashion, Design Consulting, and Finance.We are currently looking for an Insurance Verification Specialist who will be working with Connext's Client in the...
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Pasig, National Capital Region, Philippines Stark Asia Solutions, Inc Full time ₱26,000 - ₱34,000 per yearRCM – Healthcare AR Collection Specialist HiringLocation: Pasig City8-Hour Shifts | Fixed Weekends OffCan Start ASAPQualifications:At least 12 months of Healthcare AR Collections experience (Healthcare BPO – International Account)Educational Attainment:At least 2nd-year college undergraduate (1st-year college undergrad accepted if Senior High School...
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Medical Claims Specialist
1 week ago
Pasig, National Capital Region, Philippines Connext Global Solutions Inc Full time ₱40,000 - ₱80,000 per yearJob SummaryThe Medical Claims Specialist is responsible for the timely submission of technical or professional medical claims to insurance companies. This role involves verifying patient and billing information, editing claims for compliance, resolving denials, and communicating with both payers and internal teams.Responsibilities• Utilize various...
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Medical Claims Specialist
1 week ago
Pasig, National Capital Region, Philippines Connext Full time ₱400,000 - ₱800,000 per yearJob SummaryThe Medical Claims Specialist is responsible for the timely submission of technical or professional medical claims to insurance companies. This role involves verifying patient and billing information, editing claims for compliance, resolving denials, and communicating with both payers and internal teams.Responsibilities• Utilize various...
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Medical Claims Analyst
3 weeks ago
Pasig, Philippines Lennor Group Full timeOur brand, Lennor Metier Consulting, a DOLE-licensed headhunting and recruitment agency in the Philippines, is proud to partner with a global RCM Company in their search for a Medical Claims Analyst based in Ortigas. Industry: Healthcare Salary Range: ₱35,000 Package Work Setup: Onsite Work Schedule: Night Shift Location: Ortigas Job Overview We are...
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Medical Claims Analyst
2 days ago
Pasig, National Capital Region, Philippines Lennor Group Full timeOur brand, Lennor Metier Consulting , a DOLE-licensed headhunting and recruitment agency in the Philippines, is proud to partner with a global RCM Company in their search for a Medical Claims Analyst based in Ortigas .Industry: HealthcareSalary Range: ₱35,000 PackageWork Setup: OnsiteWork Schedule: Night ShiftLocation: OrtigasJob OverviewWe are looking for...
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Pasig, Philippines Nezda Technologies Inc. Full timeOverview URGENT HIRING! START ASAP! VIRTUAL PROCESS ONLY! APPLY NOW! WORK ONSITE: ORTIGAS, PASIG CITY POSITION: PHRN - PRIOR AUTHORIZATION Job Description Meticulously reviewing patient medical records, extracting key clinical data like diagnoses, medications, procedures, and laboratory results, to ensure accurate and complete information for research,...
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Medical Claims Analyst- AR
2 weeks ago
Pasig, National Capital Region, Philippines HCM Nexus Full time $40,000 - $60,000 per yearJob DescriptionWe are looking for a Medical Claims Analyst (AR) to join our growing US Healthcare team. This role involves handling both inbound and outbound calls (30% outbound) to ensure accurate and timely resolution of accounts receivable and medical claims. You'll collaborate with healthcare providers and insurance representatives to process claims...
