Healthcare Claims Analyst Position
2 weeks ago
Job Summary: We are seeking a skilled Healthcare Claims Analyst to join our team at Sourcetech Solutions Inc. This role involves reviewing and analyzing healthcare claims for accuracy, completeness, and adherence to contractual agreements and regulatory guidelines.
About the Role: As a Healthcare Claims Analyst, you will be responsible for verifying member eligibility and benefits coverage for submitted claims, evaluating medical documentation to assess the appropriateness of services rendered and coding accuracy, and adjudicating claims accurately and efficiently within established turnaround times.
Key Responsibilities:
- Review and analyze healthcare claims for accuracy, completeness, and adherence to contractual agreements and regulatory guidelines.
- Verify member eligibility and benefits coverage for submitted claims.
- Evaluate medical documentation to assess the appropriateness of services rendered and coding accuracy.
- Adjudicate claims accurately and efficiently within established turnaround times.
- Identify and investigate potential fraudulent or abusive billing practices.
- Communicate claim decisions, payment details, and denials to providers and members effectively.
- Collaborate with other departments, such as Provider Relations and Customer Service, to resolve claim-related issues and inquiries.
- Maintain comprehensive and organized claim records, documentation.
Requirements:
- Bachelor's degree in Healthcare Administration, Business, or related field
- Prior experience in healthcare claims processing or medical billing, preferably within an HMO or managed care organization
- Proficiency in medical terminology, CPT, HCPCS, and ICD-10 coding principles
- Familiarity with healthcare reimbursement methodologies, such as DRGs, RBRVS, and fee schedules
- Strong analytical and problem-solving skills with keen attention to detail
- Excellent communication skills, both verbal and written, with the ability to interact professionally with internal and external stakeholders
- Proficiency in using computerized claims processing systems and software applications
- Ability to prioritize tasks, manage workload efficiently, and meet deadlines in a fast-paced environment
Salary Estimate: $65,000 - $85,000 per year based on location and experience
-
Healthcare Claims Examiner Specialist
3 weeks ago
San Fernando, Central Luzon, Philippines SOURCETECH SOLUTIONS INC. Full time**Company Overview:**Sourcetech Solutions Inc. is a leading provider of innovative solutions for the healthcare industry.We are seeking an experienced Healthcare Claims Examiner Specialist to join our team in this exciting role.
-
Medical Claims Examiner
2 months ago
San Fernando, Central Luzon, Philippines SOURCETECH SOLUTIONS INC. Full timeJob SummaryWe are seeking a highly skilled Medical Claims Processor to join our team at Sourcetech Solutions Inc. This role is responsible for reviewing and analyzing healthcare claims for accuracy, completeness, and adherence to contractual agreements and regulatory guidelines.Key ResponsibilitiesVerify member eligibility and benefits coverage for submitted...
-
Medical Claims Specialist
1 month ago
San Fernando, Central Luzon, Philippines SOURCETECH SOLUTIONS INC. Full timeJob Summary: We are seeking a skilled Medical Claims Processor to join our team at SOURCETECH SOLUTIONS INC.. As a key member of our claims processing team, you will be responsible for reviewing and analyzing healthcare claims for accuracy, completeness, and adherence to contractual agreements and regulatory guidelines.Key Responsibilities:Verify member...
-
San Fernando, Central Luzon, Philippines Telework Full timeWe are seeking a skilled and experienced Healthcare Customer Service Representative to join our team in Pampanga. This role is perfect for individuals who enjoy working in a fast-paced environment and providing excellent customer service.As a Healthcare Customer Service Representative, you will be responsible for handling customer inquiries and resolving...
-
Patient Advocate Representative
3 weeks ago
San Fernando, Central Luzon, Philippines Valeros Business Company Full timeJob Title: Patient Advocate Representative - Healthcare SolutionsAbout Valeros Business Company:We are a leading healthcare solutions provider dedicated to delivering exceptional patient care and support.Job Description:The Patient Advocate Representative will play a vital role in our team, providing top-notch customer service, ensuring patient satisfaction,...
-
Data Analyst Position
1 month ago
San Fernando, Central Luzon, Philippines Process IT Business Process Outsourcing Services Full timeKey Responsibilities:- Interpret data to inform business decisions, leveraging analytical skills to provide actionable insights.- Design and implement databases and data systems that meet business needs, ensuring data accuracy and integrity.- Develop and deliver reports and presentations, distilling complex data into clear, concise recommendations.-...
-
Financial Data Analyst
1 week ago
San Fernando, Central Luzon, Philippines JMO Marketing Inc. Full timeJob DescriptionWe are seeking a skilled Financial Data Analyst to join our team at JMO Marketing Inc. This role is ideal for individuals with a strong background in accounting and a passion for data analysis.The successful candidate will be responsible for analyzing large datasets, identifying trends, and providing insightful recommendations to management. A...
-
Senior Financial Analyst Manager
3 weeks ago
San Fernando, Central Luzon, Philippines RCX Recruitment Inc. Full timeWe are seeking a seasoned Senior Financial Analyst Manager to join our team at RCX Recruitment Inc.Company OverviewRCX Recruitment Inc. is a leading recruitment agency dedicated to providing top talent to the industry.SalaryThe estimated salary for this position is $52,500 per annum, reflecting the company's commitment to offering competitive compensation...
-
Financial Data Analyst
3 weeks ago
San Fernando, Central Luzon, Philippines JMO Marketing Inc. Full timeWe are looking for a detail-oriented Financial Data Analyst to join our team at JMO Marketing Inc. in the United States. As a key member of our accounting department, you will be responsible for managing and analyzing financial data to ensure accuracy and compliance.About the Role:This is a full-time position that offers a competitive salary of $60,000 -...
-
Financial Analyst Professional
3 weeks ago
San Fernando, Central Luzon, Philippines SAGASS Consulting Full timeSAGASS Consulting is seeking a highly skilled and motivated Financial Analyst Professional to join our team in Rosario, Cavite.We offer a competitive salary of Php 30,000 - Php 50,000 per month, depending on experience. This is a great opportunity for individuals who want to work with a dynamic company and contribute to its growth.The successful candidate...
-
Healthcare Professional
3 weeks ago
San Fernando, Central Luzon, Philippines RCX Philippines Full timeWe are seeking a skilled and compassionate Registered Nurse to join our team at RCX Philippines. This is an exciting opportunity for a nurse who is knowledgeable in first aid, medical procedures, and patient care.About the RoleAs a Registered Nurse with RCX Philippines, you will be responsible for assisting employees during consultations, accompanying...
-
Medical Coding Specialist for Clinical Settings
20 hours ago
San Fernando, Central Luzon, Philippines Tasq Staffing Solutions Full timeAt Tasq Staffing Solutions, we are seeking a highly skilled Medical Coding Specialist to join our team in a clinical setting. As an Inpatient Medical Coder, you will be responsible for ensuring accurate and compliant coding practices within the healthcare industry.About the RoleThis is a challenging yet rewarding opportunity for experienced coders who are...
-
Financial Analyst Assistant
1 week ago
San Fernando, Central Luzon, Philippines SAGASS Consulting Full timeAbout SAGASS ConsultingWe are a dynamic consulting firm looking for talented individuals to join our team. At SAGASS Consulting, we strive to provide exceptional services to our clients and maintain a positive work environment.
-
Business Solutions Specialist
3 weeks ago
San Fernando, Central Luzon, Philippines Nityo Infotech Full timeNityo Infotech is seeking a highly skilled Business Solutions Specialist - Product Development to join our team in San Pedro, Laguna. This role involves working on product development projects and requires strong technical knowledge and communication skills.About the JobThis is a dayshift position with a work schedule from 8am to 5pm. The ideal candidate...
-
Senior Financial Analyst
2 months ago
San Fernando, Central Luzon, Philippines RIVETED SOFTWARE CORPORATION Full timeWe are seeking a highly analytical and detail-oriented professional to join our team at RIVETED SOFTWARE CORPORATION. As a Certified Public Accountant (CPA), you will be responsible for managing our company's tax and financial processes. Your key responsibilities will include filing tax forms, performing regular audits, and analyzing business transactions....
-
Senior Financial Analyst
1 week ago
San Fernando, Central Luzon, Philippines RIVETED SOFTWARE CORPORATION Full timeAbout RIVETED SOFTWARE CORPORATIONWe are a leading software corporation seeking an experienced financial expert to join our team. With a strong focus on innovation and customer satisfaction, we strive to deliver top-notch products and services.Job SummaryThis is a challenging opportunity for a highly skilled Certified Public Accountant to lead our financial...
-
Financial Operations Coordinator
1 week ago
San Fernando, Central Luzon, Philippines Cyberbacker Careers Full timeAt Cyberbacker Careers, we are seeking a highly skilled Financial Operations Coordinator to join our team. In this role, you will play a vital part in ensuring the smooth operation of our financial processes.About the RoleThe primary responsibility of this position is to oversee and manage all aspects of financial operations, including tracking cash flow,...
-
San Ildefonso, Central Luzon, Philippines Abba Personnel Services Inc. Full timeAt Abba Personnel Services Inc., we are seeking a highly skilled Staff Nurse to join our team at a state-of-the-art 300-bed hospital in Wabag, Enga, Papua New Guinea. This is an exceptional opportunity for medical professionals who want to make a meaningful difference in the lives of patients and be part of a pioneering healthcare facility in the region.The...
-
Clinical Care Specialist
4 weeks ago
San Jose del Monte, Central Luzon, Philippines SJDM- Muzon Medical Center Full timeWe are seeking a skilled Clinical Care Specialist to join our team at SJDM- Muzon Medical Center. This role is ideal for a registered professional nurse who can provide high-quality patient care while adhering to compliance standards.About the JobAs a Clinical Care Specialist, you will be responsible for providing care to patients, prioritizing their needs...
-
Nurse Practitioner
1 month ago
San Jose del Monte, Central Luzon, Philippines SJDM- Muzon Medical Center Full timeJob Title: Staff NurseJob Summary:We are seeking a skilled and compassionate Staff Nurse to join our team at SJDM- Muzon Medical Center. As a key member of our healthcare team, you will provide high-quality patient care while ensuring compliance with hospital standards.Responsibilities:Provide direct patient care while adhering to compliance...