Medical Insurance Claim Analyst

2 days ago


Taguig, National Capital Region, Philippines beBeeClaim Full time ₱625,500 - ₱751,000
Medical Biller AR Followup Specialist

ClinicMind is looking for a Medical Biller AR Followup Specialist to join their winning team.

Job Summary:

The ideal candidate will maximize insurance reimbursement for healthcare practice owners by analyzing and resolving claim denials, underpayments, and delays. They will identify root causes of claim issues and propose effective resolutions. The candidate will interact with US-based insurance carriers to follow-up on unpaid claims, delayed processing, and underpayment. Additionally, they will develop and execute medical insurance claim denial appeal processes and collaborate with US-based practice owners and clinicians to complete and correct missing or incorrect data on insurance claims.

Key Responsibilities:
  1. Analyze and resolve claim denials, underpayments, and delays to maximize insurance reimbursement for healthcare practice owners.
  2. Identify root causes of claim issues and propose effective resolutions to improve the overall performance of the team.
  3. Interact with US-based insurance carriers to follow-up on unpaid claims, delayed processing, and underpayment, ensuring timely resolution of issues.
  4. Develop and execute medical insurance claim denial appeal processes, working closely with practice owners and clinicians to ensure accurate and complete claims submissions.
  5. Collaborate with US-based practice owners and clinicians to complete and correct missing or incorrect data on insurance claims, minimizing delays and ensuring timely payments.
Requirements:
  1. A minimum of 6 months experience in US-based AR follow-up and charge and payment posting.
  2. A college degree in Computer Engineering, Mathematics, or similar field.
  3. Hands-on experience with data analysis and data classification.
  4. Excellent analytical skills and attention to detail.
  5. Familiarity with the US medical insurance industry and insurance claims processing cycle.
  6. Knowledge of ICD-10, CPT, and HCPC coding systems.
  7. Understanding of CMS-1500 and UB-04 claim formats.
  8. Prior experience with Vericle Software is an advantage.
  9. Strong listening, communication, and problem-solving skills.
  10. Self-motivated and able to work autonomously.
Must-Haves:
  1. A high comfort level working on Eastern Time Zone/US Shift.
  2. Good internet access at home.
  3. A mobile hotspot.
  4. A laptop/Desktop with at least 8 GB of RAM.


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