Healthcare Claims Specialist

1 week ago


Manila, National Capital Region, Philippines UST Full time

As a Healthcare Claims Specialist at UST, you will play a crucial role in processing new claims and modifying existing ones according to the appropriate and applicable action. This involves analyzing claims to determine the correct course of action to approve or deny payment.

You will be responsible for determining accurate payment criteria for clearing pending claims based on defined policies and procedures. Additionally, you will research claims edits to determine the appropriate benefit application utilizing established criteria, and apply physician contract pricing as needed for entry-level claims.

Your attention to detail will be essential in reviewing and addressing provider inquiries regarding claim adjudication. You will also demonstrate increasing productivity to meet minimum requirements while maintaining quality standards.

Requirements:

  • At least 2 years of medical claims processing experience
  • Knowledge in US healthcare practice, medical coding (ICD-10, CPT4, DRG, HCPCS), clinical documentation improvement, medical terminologies, EDI - HIPAA protocol
  • Ability to multi-task and follow documented claims processes with minimal supervision
  • Excellent verbal and written business communication skills
  • Experience in medical coding, including diagnosis coding and terminology, is an advantage
  • Strong attention to detail and the ability to make appropriate decisions based on information presented
  • Ability to work on high volume of repetitive claims
  • Amenable to start onsite


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