Medical Claims AR Specialist

4 weeks ago


Ortigas Pasig, Philippines Visaya KPO Full time

The AR Specialist III is responsible for post-payment and account follow-up and/or grievance preparation of assigned client accounts receivable. Working at a client site or in a centralized location, responsibilities may include account maintenance of specialized or multiple payers including state and federal government programs, managed care, commercial and other insurance groups. This role may also serve as a liaison to clinical auditors, other team members, client staff, government agencies and health plans to facilitate the appropriate and prompt payment of claims.

Duties & Responsibilities

> Verify/obtain eligibility and/or authorization utilizing payer web sites, client eligibility systems or via phone with the insurance
carrier/providers
> Update patient demographics/insurance information in appropriate systems Research/ Status unpaid or denied claims
> Monitor claims for missing information, authorization, and control numbers (ICN//DCN)
> Research EOBs for payments or adjustments to resolve claim
> Contacts payers via phone or written correspondence to secure payment of claims Access client systems for payment, patient, claim and data info
> Follows guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systems
> Secure needed medical documentation required or requested by third party insurance carriers.
> Maintain confidentiality of patient information in accordance with insurance collection guidelines and corporate policy and procedure
> Perform other related duties as required
> Utilize provider billing manuals to obtain billing guidelines and requirements.
> Write appeal letters for technical appeals
> Verifies accuracy of underpayments utilizing contracts and claims data.
> Prepares claims for clinical audit processing in the case of authorization, coding, level of care and/or length of stay denials
> Utilizes reports for analysis and to monitor follow up activities and prioritization
> Assists organization with working through special projects as needed
> SME for colleagues and provide direction for resolution of accounts
> Assists in new hire training
> Assists in content building of training materials

Qualifications & Competencies

> 3+ years of medical collections/billing experience
> Intermediate knowledge of ICD-10, CPT, HCPCS and NCCI
> Expert knowledge of third-party billing guidelines
> Expert knowledge of billing claim forms (UB04/1500)
> Expert knowledge of payor contracts
> Working Knowledge of Microsoft Word and Excel
> Intermediate working knowledge of health information systems (i.e., EMR, Claim Scrubbers, Patient Accounting Systems, etc.)

Preferred Qualifications

> Working knowledge of one or more of the following Patient accounting systems – EPIC, Cerner, STAR, Meditech, CPSI, Invision, PBAR, All > > Scripts or Paragon
> Prior team lead experience
> Working knowledge of DDE Medicare claim system
> Knowledge of government rules and regulations



  • Ortigas, Pasig, Philippines Visaya KPO Full time

    The AR Specialist III is responsible for post-payment and account follow-up and/or grievance preparation of assigned client accounts receivable. Working at a client site or in a centralized location, responsibilities may include account maintenance of specialized or multiple payers including state and federal government programs, managed care, commercial and...


  • Ortigas, Pasig, Philippines Visaya KPO Full time

    The AR Specialist III is responsible for post-payment and account follow-up and/or grievance preparation of assigned client accounts receivable. Working at a client site or in a centralized location, responsibilities may include account maintenance of specialized or multiple payers including state and federal government programs, managed care, commercial and...


  • Ortigas, Pasig, Philippines VISAYA Full time

    The AR Specialist II is responsible for billing, re-billing, post-payment/account follow-up, and grievance preparation of assigned. Client Hospital Accounts Receivable. Working at a Client site or in a Centralized location, responsibilities may include account maintenance of specialized or multiple payers including state and federal government programs,...


  • Ortigas, Pasig, Philippines VISAYA Full time

    The AR Specialist II is responsible for billing, re-billing, post-payment/account follow-up, and grievance preparation of assigned. Client Hospital Accounts Receivable. Working at a Client site or in a Centralized location, responsibilities may include account maintenance of specialized or multiple payers including state and federal government programs,...


  • Ortigas, Pasig, Philippines Visaya KPO Full time

    Duties & Responsibilities > Verify/obtain eligibility and/or authorization utilizing payer web sites, client eligibility systems or via phone with the insurance carrier/providers > Update patient demographics/insurance information in appropriate systems > Research/ Status unpaid or denied claims > Monitor claims for missing information, authorization, and...


  • Ortigas, Pasig, Philippines Visaya KPO Full time

    Duties & Responsibilities > Verify/obtain eligibility and/or authorization utilizing payer web sites, client eligibility systems or via phone with the insurance carrier/providers > Update patient demographics/insurance information in appropriate systems > Research/ Status unpaid or denied claims > Monitor claims for missing information, authorization, and...


  • Ortigas, Pasig, Philippines Visaya KPO Full time

    Duties & Responsibilities > Verify/obtain eligibility and/or authorization utilizing payer web sites, client eligibility systems or via phone with the insurance carrier/providers > Update patient demographics/insurance information in appropriate systems > Research/ Status unpaid or denied claims > Monitor claims for missing information, authorization, and...


  • Ortigas, Pasig, Philippines Visaya KPO Full time

    Duties & Responsibilities > Verify/obtain eligibility and/or authorization utilizing payer web sites, client eligibility systems or via phone with the insurance carrier/providers > Update patient demographics/insurance information in appropriate systems > Research/ Status unpaid or denied claims > Monitor claims for missing information, authorization, and...


  • Ortigas, Pasig, Philippines VISAYA Full time

    The AR Specialist II is responsible for billing, re-billing, post-payment/account follow-up, and grievance preparation of assigned. Client Hospital Accounts Receivable. Working at a Client site or in a Centralized location, responsibilities may include account maintenance of specialized or multiple payers including state and federal government programs,...


  • Ortigas, Pasig, Philippines VISAYA Full time

    The AR Specialist II is responsible for billing, re-billing, post-payment/account follow-up, and grievance preparation of assigned. Client Hospital Accounts Receivable. Working at a Client site or in a Centralized location, responsibilities may include account maintenance of specialized or multiple payers including state and federal government programs,...

  • Claims Encoder

    2 months ago


    Ortigas, Pasig, Philippines TOPSERVE SERVICE SOLUTION, INC. Full time

    Qualifications: Graduate of any four year course. Computer literate Willing to be assigned in MEDASIA With technical knowledge pertaining to medical terminologies, needed for the job is an advantage. With good communication / interpersonal skills Willing to start ASAP

  • IP/OP Medical Coder

    2 months ago


    Ortigas City, Philippines RSD Human Resource Management Consultancy Full time

    Job Title: Medical Coder Job Overview: A medical coder plays a critical role in the healthcare industry by translating medical diagnoses, procedures, and services into universal alphanumeric codes. These codes are essential for billing, insurance claims processing, and maintaining accurate patient records. Key Responsibilities: Reviewing Patient Records:...

  • IP/OP Medical Coder

    4 weeks ago


    Ortigas City, Philippines RSD Human Resource Management Consultancy Full time

    Job Title: Medical Coder Job Overview: A medical coder plays a critical role in the healthcare industry by translating medical diagnoses, procedures, and services into universal alphanumeric codes. These codes are essential for billing, insurance claims processing, and maintaining accurate patient records. Key Responsibilities: Reviewing Patient Records:...

  • Medical Coders

    2 weeks ago


    Ortigas, Pasig City, Philippines RSD Human Resources Management Department Full time

    Open positions:Inpatient CoderOutpatient Coder Salary: 50, ,000Outpatient Coding Trainer Salary: 59,700Clinical Denials QACDISpecialist Salary: 35, ,000 Qualifications:PHRN - Certified Medical Coder (COC, CCS, CPC, CIC and etc.

  • IP/OP Medical Coder

    2 months ago


    Ortigas City, Philippines RSD Human Resource Management Consultancy Full time

    Job Title: Medical Coder Job Overview: A medical coder plays a critical role in the healthcare industry by translating medical diagnoses, procedures, and services into universal alphanumeric codes. These codes are essential for billing, insurance claims processing, and maintaining accurate patient records. Key Responsibilities: Reviewing Patient Records:...

  • IP/OP Medical Coder

    4 weeks ago


    Ortigas City, Philippines RSD Human Resource Management Consultancy Full time

    Job Title: Medical Coder Job Overview: A medical coder plays a critical role in the healthcare industry by translating medical diagnoses, procedures, and services into universal alphanumeric codes. These codes are essential for billing, insurance claims processing, and maintaining accurate patient records. Key Responsibilities: Reviewing Patient Records:...


  • Pasig, National Capital Region, Philippines Visaya Knowledge Process Outsourcing Corp Full time

    Duties & ResponsibilitiesVerify/obtain eligibility and/or authorization utilizing payer web sites, client eligibility systems or via phone with the insurance carrier/providersUpdate patient demographics/insurance information in appropriate systems Research/ Status unpaid or denied claimsMonitor claims for missing information, authorization, and control...

  • IP/OP Medical Coder

    2 weeks ago


    Ortigas City, Philippines RSD Human Resource Management Consultancy Full time

    Job Title: Medical CoderJob Overview:A medical coder plays a critical role in the healthcare industry by translating medical diagnoses, procedures, and services into universal alphanumeric codes. These codes are essential for billing, insurance claims processing, and maintaining accurate patient records.Key Responsibilities:Reviewing Patient Records: Analyze...

  • Clinical Appeals Nurse

    2 months ago


    Ortigas, Pasig, Philippines RSD Human Resource Management Consultancy Full time

    As a Clinical Appeals Nurse, you will be responsible for reviewing denied claims and treatment requests to ensure appropriate reimbursement for medical services rendered. You will analyze medical records, insurance policies, and clinical guidelines to develop compelling appeals for denied claims. Your expertise in healthcare regulations and reimbursement...

  • Clinical Appeals Nurse

    2 months ago


    Ortigas, Pasig, Philippines RSD Human Resource Management Consultancy Full time

    As a Clinical Appeals Nurse, you will be responsible for reviewing denied claims and treatment requests to ensure appropriate reimbursement for medical services rendered. You will analyze medical records, insurance policies, and clinical guidelines to develop compelling appeals for denied claims. Your expertise in healthcare regulations and reimbursement...