Medical Claims Professional
6 days ago
About Penbrothers
We strive to be a leading HR & remote talent management partner, offering talented Filipinos global opportunities in high-growth startups and dynamic companies from the comfort of their own homes.
About the Client
Our client is a venture-backed startup that aims to establish a new standard of affordable, preventative care beyond traditional hospital settings. They achieve this by enabling independently-owned practices to accept and work with insurance profitably. The client champions the voices of small private practices in an industry dominated by large health systems. Through strategic partnerships with insurance carriers, they eliminate the risk and administrative hurdles associated with insurance, empowering entrepreneurial providers to launch and expand successful in-network practices, ultimately increasing access to affordable healthcare across the US.
About the Job
We are seeking a skilled Medical Billing and Claims Specialist to join our revenue operations team. In this role, you will oversee the entire claims management process, including daily claim submissions, posting payments, denials management, and client billing support. You will work closely with providers, patients, and insurance companies to resolve billing issues, process claims, and ensure compliance with healthcare regulations.
Responsibilities:
- Quality control and execution of daily claim submissions and payment transactions.
- Daily reconciliation of charges, adjustments, and payments.
- Claims follow-up and submission of reconsiderations and appeals as needed.
- Professional interactions with providers and clients, with sensitivity to financial discussions.
- Maintenance and enhancement of knowledge on revenue cycle operations.
- Team notification of changes in insurance company policies and guidelines.
- Support with other functions as needed.
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