Healthcare Claims Representative

4 days ago

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

Experience these exceptional benefits when you join Med-Metrix

  • 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

Job Purpose

The Healthcare Claims Representative is responsible for collections, account follow up, billing and allowance posting for the accounts assigned to them.

Duties and Responsibilities

  • Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or websites.
  • Meets and maintains daily productivity/quality standards established in departmental policies.
  • Uses the workflow system, client host system and other tools available to them to collect payments and resolve accounts.
  • Adheres to the policies and procedures established for the client/team.
  • Knowledge of timely filing deadlines for each designated payer.
  • Performs research regarding payer specific billing guidelines as needed.
  • Ability to analyze, identify and resolve issues causing payer payment delays.
  • Ability to analyze, identify and trend claims issues to proactively reduce denials.
  • Communicates to management any issues and/or trends identified.
  • Initiate appeals when necessary.
  • Ability to identify and correct medical billing errors.
  • Send appropriate appeals, accurate requesting information, supporting documentation, and effective communication to complete recovery process.
  • Understanding of under or over payments and credit balance processes.
  • Assist with special A/R projects as needed. Analytical skills and the ability to communicate results are required.
  • 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.
  • Other duties as assigned by the management team

Qualifications

  • Completed at least High School education
  • At least 1 year 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), required.
  • Must have experience in utilizing Cerner system.
  • Experienced on medical billing/ AR Collections.
  • Background in calling insurance (Payer) to verify claim status and payment dispute.
  • Must be amenable to work during US hours
  • Must be amenable to work onsite in Ortigas, Pasig City

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. Ability to lift heavy equipment and perform manual labor as needed
  • Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
  • Work Environment: The noise level in the work environment is usually minimal.
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