Healthcare CSR

2 weeks ago

Manila, National Capital Region, Philippines weSource Management Consultancy Firm Full time

We are looking for CSRs for a client in the Healthcare Industry.

This role is on a REMOTE setup and follows a Night Shift Schedule.

Salary pays up to 35K Package.

Minimum requirement of at least 3 years of Healthcare experience in a BPO setup.

Essential Duties and Responsibilities:

  • Processes opportunities, such as verifying benefits, requesting authorization, & following up on auth-requests.
  • Completes data fields within the system with insurance information needed for claim submission, start & end dates of authorization, and others.
  • Prepares correspondence to insurance companies, Health Care Professionals (HCPs) & other affiliates on behalf of patients, such as authorization requests, appeals & letters of agreement.
  • Clearly documents all correspondence in the company databases.
  • Troubleshoots and seeks solutions to problems related to questions and concerns over authorization and claims.
  • When other team members are absent or not available, provides backup coverage for their territories/insurance/state.
  • Support education of team members on insurance verification, authorization, and claims.
  • Analyze and investigate denied claims and find ways/resolution for payment.
  • Do outbound calls to different insurance companies to confirm information, submit/validate an authorization or claim submission/denials.
  • Identify denial patterns and escalate to management as appropriate with sufficient information for additional follow-up and/or root cause resolution.
  • Assumes and performs other duties as assigned.

Required Qualifications:

STRONG US HEALTHCARE COMPREHENSION:

  • Must understand the intricacies of medical and pharmacy insurance coverage.
  • Must know and understand the difference between HMO, PPO, EPO, Indemnity, POS, Home Plans and Host Plans and be able to clearly communicate that to a patient and or another caregiver or medical professional.
  • Must understand different denial reasons and claim status.
  • Must understand CPT/HCPC codes, ICD 10, claim forms.
  • Ability to learn and retain the specific criteria and requirements for different insurance plans.

STRONG COMPUTER AND PHONE SKILLS:

  • Must be able to create Word documents, work in Excel, use templates, use the internet, Outlook and work in a company created database.
  • Must be pleasant and knowledgeable when speaking with insurance company representatives.

Preferred Qualifications:

  • 3 years of US HEALTHCARE experience Authorization and billing experience or insurance collections preferred.
  • Proven knowledge of and experience with ICD-9/10, HCPCS, and modifier coding.
  • Outstanding interpersonal, verbal, and written communications skills required.
  • Must be flexible and able to work in a fast-paced, heavy volume work environment.
  • Demonstrated computer, prioritization, and time management skills.
  • Experience working at insurance companies/payors or with medical device reimbursement for a start-up or new technology company or durable medical equipment setting is highly desirable.

Education and Experience Requirements:

  • Bachelors degree preferred.

Language Skills:

  • Must be able to communicate effectively in English.
  • Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
  • Ability to write routine reports and correspondence.
  • Ability to speak effectively before groups of customers or employees of organization.
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