Claims Process Specialist

21 hours ago

Ayala Alabang, National Capital Region, Philippines beBeeMedical Full time $45,000 - $60,000
Job Title: Medical Claims Specialist

Position Summary:

The role of a Medical Claims Specialist is pivotal within our healthcare team, focused on scrutinizing medical claims, investigating rejections and denials, and documenting associated account activities.

This position demands an in-depth understanding of eligibility criteria and payment methodologies, along with the capability to record adjustments in accordance with government regulations and payer contracts.

Key Responsibilities:

  • Verify patient eligibility and benefits for accurate coverage.
  • Submit claims in a timely and compliant manner.
  • Obtain prior authorizations to support smooth claim approvals.
  • Monitor medical claim status and conduct follow-up to ensure prompt payment.
  • Research and resolve claim rejections and denials to prevent future occurrences.
  • Generate and submit patient statements without patient interaction.
  • Document all account activities accurately and promptly.
  • Post manual payments, apply adjustments, and manage collections from various payers.
  • Understand and apply Medicare, Medicaid, and commercial insurance requirements and payment methodologies.
  • Record contractual adjustments based on payer contracts and government regulations.
  • Maintain proficiency with billing systems to efficiently process claims.
  • Stay up-to-date with changes in billing and coding guidelines, payer contracts, and government regulations.

Requirements:

  • A minimum of 2 years of experience in end-to-end revenue cycle processes is required.
  • Prior experience in DME and Apero is preferred.
  • Candidates must demonstrate collaboration skills and work effectively with team members and healthcare providers.
  • Candidates should be able to handle high-pressure situations in a fast-paced environment.
  • Excellent customer service skills are necessary for interacting with patients, insurance companies, and healthcare providers.

Benefits:

We offer a competitive compensation package that includes opportunities for growth and development. Our team provides a supportive and collaborative environment, ideal for professionals seeking to advance their careers in medical billing and coding.

About the Role:

This position offers a unique opportunity to work with a dynamic team dedicated to delivering exceptional healthcare services. As a Medical Claims Specialist, you will play a vital role in ensuring seamless claim processing and resolution.

Please note that this job posting is for informational purposes only, and any information provided is subject to change without notice.

],

  • Healthcare Claims Specialist

    4 days ago

    Ayala Alabang, National Capital Region, Philippines beBeeClaims Full time ₱20,000 - ₱23,000

    Job Title: Healthcare Claims SpecialistWe are seeking a highly skilled and detail-oriented individual to fill the role of Healthcare Claims Specialist. As a key member of our team, you will be responsible for ensuring accurate and timely processing of healthcare claims.Key Responsibilities:Outbound Calling: Make outbound calls to insurance companies and...

  • Healthcare Insurance Claims Specialist

    1 day ago

    Ayala Alabang, National Capital Region, Philippines beBeeInsurance Full time ₱240,000 - ₱420,000

    Job SummaryWe are seeking a detail-oriented professional to join our team as an Insurance Claims Specialist.Key Responsibilities:Verify patient insurance coverage and benefits, both online and via phone calls.Code claims using acceptable codes provided by the healthcare facility.Review claims for potential denials and ensure compliance with insurer...

  • Healthcare Claims Specialist

    2 hours ago

    Ayala Alabang, National Capital Region, Philippines beBeeMedical Full time ₱450,000 - ₱750,000

    Medical Claims SpecialistA Medical Biller plays a crucial role in the healthcare industry, responsible for submitting claims to insurance companies.The successful candidate will process data from medical coders, ensuring timely payment of claims. Key responsibilities include verifying insurance coverage, reviewing denied claims, and assisting patients with...

  • Medical Claim Review Specialist

    2 weeks ago

    Ayala Alabang, National Capital Region, Philippines beBeeMedicine Full time ₱50,000 - ₱65,000

    Medical Claim Review SpecialistAbout the RoleThis role requires a high level of analytical and problem-solving skills, as well as excellent communication and interpersonal skills. As a medical claim review specialist, you will be responsible for reviewing medical claims for medical necessity.Assess and interpret customer needs, requirements, and medical...

  • Medical Claims Reimbursement Expert

    19 hours ago

    Ayala Alabang, National Capital Region, Philippines beBeeBillers Full time ₱500,000 - ₱1,000,000

    Medical Biller AR Follow-up SpecialistWe are seeking a highly skilled Medical Biller AR follow-up specialist to join our team. If you're passionate about healthcare and have experience in revenue cycle management, we'd like to hear from you.Responsibilities:Maximize insurance reimbursement for healthcare providers by identifying and resolving claim denials,...

  • Medical Claims Specialist

    1 day ago

    Ayala Alabang, National Capital Region, Philippines beBeeMedicalBiller Full time ₱450,000 - ₱600,000

    Medical Biller Job OverviewOur organization is seeking a highly skilled and detail-oriented Medical Biller to play a critical role in our operations. The ideal candidate will possess strong organizational skills, exceptional accuracy in data entry, and experience in managing medical claims and insurance processes.Job ResponsibilitiesAccurately input claim...

  • Medical Billing Specialist

    22 hours ago

    Ayala Alabang, National Capital Region, Philippines beBeeRecovery Full time ₱40,000 - ₱60,000

    Revenue Cycle Operations SpecialistWe are seeking a detail-oriented Revenue Cycle Operations Specialist to support our revenue cycle operations. This role is primarily focused on reducing claim denials and recovering aging or stale claims.This individual will work directly in our billing system, managing claim queues, and communicating with payers to ensure...

  • Claims Assistant

    1 week ago

    Ayala Alabang, National Capital Region, Philippines WHR Global Consulting Full time $40,000 - $60,000 per year

    Position Title: Claims Assistant (Motor Claims)Work Location: AlabangWork Setup: OnsiteWork Schedule: Day ShiftQualifications-Graduate of any 4-year bachelor's degree-Experience in motor claims insurance processing is a plus-Exceptional written and verbal communication skills-Proficiency in MS Word and Excel-Detail-oriented with strong analytical...

  • Claims Processor

    1 week ago

    Ayala Alabang, National Capital Region, Philippines WHR Global Consulting Full time ₱104,000 - ₱130,878 per year

    POSITION TITLE: Claims Assistant (Non-motor Insurance)WORK LOCATION: AlabangWORK SETUP: Onsite alwaysWORK SCHEDULE: Day ShiftQUALIFICATIONS:-Graduate of any 4-year bachelor's degree.-2–4 years experience in Non-Motor Claims or prior experience in a claims department or working with insurance claims is a significant advantage.-Experience in handling...

  • Medical Billing Claims Specialist

    2 weeks ago

    Ayala Alabang, National Capital Region, Philippines WHR Global Consulting Full time

    OverviewPOSITION TITLE: Medical Billing and Insurance Claims SpecialistWORK LOCATION: Alabang, MuntinlupaWORK SETUP: OnsiteWORK SCHEDULE: Night ShiftQualificationsMinimum of 1 year of experience in medical billing, insurance claims, or a related fieldMust have at least 6 months of BPO experience handling healthcare accountsStrong English proficiency, both...