Healthcare Claims Specialist

21 hours ago

Pasig, National Capital Region, Philippines beBeeMedicalClaimsSpecialist Full time ₱350,000 - ₱550,000

Seeking a skilled Medical Claims Specialist to join our team in the healthcare industry. This dynamic role involves complex claims EDI charge capture and claim submission.

We are looking for someone with excellent organizational skills, attention to detail, and strong communication skills to handle day-to-day tasks efficiently.

The ideal candidate will have a basic knowledge of healthcare claims submissions and processing including ICD-10, CPT, and HCPC codes, LCD guidelines, rejections, clearinghouse, as well as 1500 forms.

Able to work well individually and in a team environment with minimal supervision. Must be able to analyze, identify and resolve issues which may be causing payer payment delays.

This role is perfect for someone who enjoys working in a fast-paced environment with opportunities for growth and professional development.

We offer a comprehensive benefits package, ongoing training and staff development, and employee engagement activities.

Key Responsibilities
  • Reviews referrals to ensure that all charges for each date of service have been captured
  • Where appropriate, completes charge corrections into billing system based off office documentation
  • Meets and maintains daily productivity and quality standards established in departmental policies
  • Adheres to the policies and procedures established for the client/team
  • Verify and ensure that the patients demographics are properly entered in the host system, correcting errors when necessary and verifying that proper authorizations are entered
  • Perform special projects and other duties as needed
Requirements
  • High school diploma or equivalent required
  • Previous experience in Hospital/Facility or Physician billing: preferred
  • Experience with EPIC preferred
  • Basic knowledge of healthcare claims submissions and processing including ICD-10, CPT, and HCPC codes, LCD guidelines, rejections, clearinghouse, as well as 1500 forms
  • Knowledge of various types of insurance plans, CPT, ICD-10, billing guidelines
  • Ability to work well individually and in a team environment
  • Strong communication skills/oral and written
  • Strong organizational skills, with a strong attention to detail
Working Conditions
  • Work Set-Up: Onsite
  • Work Schedule: Night shift, US hours
  • 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.
  • 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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