US Medical Claims Specialist

6 days ago

Manila, National Capital Region, Philippines Optum, a UnitedHealth Group Company Full time

Primary Responsibilities:

  • Contract reading of payment dispute.
  • Working on the Provider side.
  • Checking with the insurance to verify claim status and collect unpaid claims.
  • Process claims payment, Denial Management, Claim statusing.

JOB QUALIFICATIONS

  • Completed at least 2 years in college.
  • With minimum 12 months experience of Healthcare Account Receivable/Collections 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 UB04 forms.
  • Experienced on medical billing/AR Collections.
  • Background in calling insurance (Payer) to verify claim status and payment dispute.
  • Used and familiar with EPIC SYSTEM as an activity tool.
  • Willing to work on-site in Alabang.

Note: Experience in a BPO Healthcare Account is Required.

ROLE AND RESPONSIBILITIES

This function is responsible for Collections for Healthcare unpaid claims. This position in this function interacts 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. Educate customers regarding the availability of receiving claims and remitting payments through online applications. Monitor outstanding balances and take appropriate actions to ensure clients pay as billed. Manage the preparation of invoices and complete reconciliation of billing with accounts receivables. May also include quality assurance and audit of collection activities.

Blended Account process documents, emails and calls.
Moderate work experience within own function.
Some work is completed without established procedures.
Basic tasks are completed without review by others.
Supervision/guidance is required for higher level tasks.

The role is responsible for accounts receivable collections, follow-up, involves denial management, claims payment processing tracking and status and appeals for hospital process.

Your role is critical in allowing our members, families, facilities and health professionals to have greater confidence in the exceptional care we provide. And for you, an everyday opportunity to do your life's best work.

WHAT WE OFFER

  • Market Competitive Pay Levels.
  • Fast Processing No Exam Hiring.
  • Retirement Plan.
  • Medical Plan (HMO) from Day 1 of employment.
  • Dental, Medical, and Optical Reimbursements.
  • Life and Disability Insurance.
  • Paid Time-Off Benefits.
  • Sick Leave Conversion.
  • Tuition Fee Reimbursement.
  • Employee Assistance Program (EAP).
  • Annual Performance Based Merit Increases.
  • Employee Recognition.
  • Training and Staff Development.
  • Employee Referral Program.
  • Employee Volunteerism Opportunity.
  • All Mandatory Statutory Benefits.

WHO WE ARE

  • Optum is the health care technology and innovation company of the UnitedHealth Group enterprise along with UnitedHealthcare.
  • UnitedHealth Group is a health care and well-being company with a mission to help people live healthier lives and help make the health system work better for everyone.
  • We're a leading health solution and care delivery organization. Our work is complex, but our mission is simple: create a healthier world, with you at the center.
  • As part of a Fortune 5 enterprise, we are improving the health care experience of over 125 million people around the world.
  • We're a diverse team with operations across North America, South America, Europe, Asia Pacific and the Middle East. This includes our over 25,000 employees in the Philippines.
  • Elevate your career with a leading health care company while improving lives.

Join us in evolving health care so everyone can have the opportunity to live their healthiest life. This is your opportunity to be part of a team that's dedicated to Caring. Connecting. Growing together.

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