Medical Management Resolution Specialist

2 days ago

Pasig, National Capital Region, Philippines beBeeManagement Full time ₱900,000 - ₱1,200,000
Job Overview

We are seeking a detail-oriented professional to fill the role of Medical Management Resolution Specialist. The ideal candidate will have experience in medical coding within the US healthcare system and a strong background in medical management resolution.

Key Responsibilities
  • Collect, verify, and input information accurately to ensure seamless transitions to clinical review.
  • Conduct thorough reviews of disputed medical claims to determine the medical necessity of services provided to members.
  • Collaborate with healthcare providers, coders, and payers to clarify documentation and ensure accurate coding and claim resolution.
  • Assist in resolving denials, discrepancies, and other issues related to medical management and billing.
  • Maintain detailed records of case resolutions and communicate updates to relevant stakeholders.
  • Support process improvement initiatives to enhance accuracy and efficiency in medical management resolution.
  • Ensure compliance with regulatory standards.
  • Accurately input case details, clinical data, and communications into internal systems.
  • Maintain records of all correspondence, decisions, and outcomes related to IDR cases.
  • Ensure all documentation is complete and compliant with federal regulations.
  • Facilitate communication between clinical teams and administrative staff to ensure accurate and timely submissions.
Required Skills and Qualifications
  • College level education.
  • Minimum of 2 years related experience in medical management resolution or administrative work in utilization management.
  • Certified Medical Coders or Non-Certified Experienced Medical Coders with US healthcare experience is an advantage.
  • Strong understanding of medical coding systems and healthcare terminology.
  • Excellent problem-solving, communication, and analytical skills.
  • Willingness to work onsite in Ortigas and on a night shift schedule.
  • Detail-oriented with the ability to manage multiple cases efficiently.
Benefits
  • 15% Night Differential
  • HMO coverage after 30 days of employment (with option to add up to 2 dependents)
  • Retirement Benefits
  • 24 Leave Credits per year (convertible to cash)
  • Wholistic Employee Wellness Program
About Us

We are a multi-awarded company recognized for leadership and innovation in the outsourcing industry. We value professional growth, employee well-being, and long-term partnerships.

Job Type: Full-time

  • Claims Resolution Specialist

    1 day ago

    Pasig, National Capital Region, Philippines beBeeClaims Full time ₱250,000 - ₱450,000

    Job Title:Claims Resolution SpecialistDescription:We are seeking a detail-oriented and organized individual to support our Collections and/or Denial Management department. The successful candidate will be responsible for gathering and disseminating information from hospitals and insurance companies related to referred claims.Responsibilities:Verify member...

  • Medical Claims Resolutions Expert with Sign-On Bonus

    2 hours ago

    Pasig, National Capital Region, Philippines beBeeClaims Full time ₱900,000 - ₱1,200,000

    We are seeking a Claims Resolution Specialist to join our team. In this role, you will be responsible for investigating and resolving denied health insurance claims through thorough analysis and problem-solving.Key ResponsibilitiesInvestigate and resolve denied health insurance claimsAnalyze claim data to determine the validity of refund claimsDraft...

  • Medical Coding Trainer

    3 days ago

    Pasig, National Capital Region, Philippines beBeeInpatient Full time ₱45,000 - ₱85,000

    About this roleWe are seeking a skilled professional to support the development and delivery of comprehensive training programs related to medical coding and billing.This role is responsible for designing instructional materials, conducting assessments, and providing onboarding and refresher training sessions to support coder readiness, compliance, and...

  • Global Medical Evacuation Specialist

    4 days ago

    Pasig, National Capital Region, Philippines beBeeHealthcare Full time ₱800,000 - ₱1,200,000

    Medical Operations Specialist JobWe are seeking a career-minded nurse looking for a change in their professional path to join our medical operations team. In this role, you will be responsible for staffing emergency access telephone lines in our operations center, responding to client health events and other emergencies, deploying both domestically and...

  • Medical Care Specialist

    24 hours ago

    Pasig, National Capital Region, Philippines beBeeNursing Full time ₱800,000 - ₱1,200,000

    About the RoleWe are seeking a highly skilled and compassionate Nurse to join our team. As a Nurse, you will be responsible for providing high-quality patient care in a fast-paced office clinic setting.Care for and treat patients: You will assess patients' conditions, administer medication, dress wounds, interpret physicians' instructions, assist with...

  • Medical Necessity Specialist

    2 days ago

    Pasig, National Capital Region, Philippines beBeeCaregiver Full time ₱800,000 - ₱1,200,000

    Utilization Review NurseThe primary role of this position is to ensure patients receive appropriate, timely, and cost-effective care by reviewing medical records, treatment plans, and healthcare resource utilization.Conduct concurrent and retrospective reviews of patient clinical information to guarantee medical necessity, appropriateness, and efficiency of...

  • Medical Operations Specialist

    4 days ago

    Pasig, National Capital Region, Philippines Global Rescue Full time

    OverviewWe are currently seeking nurses looking for a career change to join our growing operations teams. In this role you will staff emergency access telephone lines in our operations centers to respond to client health events and other emergencies, deploy both domestically and internationally in support of medical evacuations, and perform a combination of...

  • Training Specialist

    2 days ago

    Pasig, National Capital Region, Philippines beBeeTraining Full time ₱900,000 - ₱1,200,000

    Job DescriptionWe are seeking a skilled professional to lead our training programs. The ideal candidate will have a strong background in medical billing and revenue cycle management, with experience in developing curriculum, training syllabus, and course modules.Responsibilities:Develop Training Programs: Create comprehensive training programs for new and...

  • Project Manager

    2 days ago

    Pasig, National Capital Region, Philippines The Medical City Full time

    The Medical City Ortigas is searching for an experienced Project Manager to join the team and help lead the organization to the next level. This role is crucial for managing construction and fit-out renovations, and monitors project cost, timelines, and quality of works. This role is also responsible for managing projects that are being done by outsourced...

  • URGENT Medical Allied College Grad.

    4 weeks ago

    Pasig, National Capital Region, Philippines HRTX Full time

    Must be a graduate of any Medical Allied course (e.g., Nursing, MedTech, Pharmacy, PT, RadTech, etc.) With at least 6 months of BPO or Customer Service experience handling US Healthcare account (preferably voice account and Prior Authorization knowledge) Excellent English communication skills Amenable to work on night shifts, weekends, and holidays ...