Medical Claims Professional

5 days ago

Marikina City, National Capital Region, Philippines beBeeCollections Full time $60,000 - $90,000

At Limitlessli, we specialize in recruiting and managing high-caliber remote staff for dynamic healthcare facilities.

The Opportunity:

This role involves managing all third-party billing and collections functions for assigned accounts in the revenue cycle. The successful candidate will manage billing processes to secure payments within defined company guidelines for various payers.

Key Responsibilities:
  • Coordinate accumulation of information with various departments; post to resident accounts.
  • Review charges for accuracy, completeness, consistency, and payers charged.
  • Prepare and timely issue accurate billing statements to the correct payer using electronic systems provided.
  • Monitor all submissions on a daily basis to address any denials or requests for additional information (ADRs).
  • Coordinate with all departments and submit ADR information within 10 days of receipt of request.
Collections Responsibilities:
  • Follow up on unpaid claims/denials within company standard billing cycle timeframes; determine reasons for denial. Correct claims and re-bill when required.
  • Document all communications and collection attempts, taking follow-up action in accordance with established policies and procedures.
  • Provide needed supporting documentation to payer upon request in a timely manner.
  • Maintain A/R aging levels for assigned accounts within company guidelines.
  • Notify supervisors of difficult/problem accounts; residents unwilling or unable to pay balances.
  • Process claim reclassification to private accounts upon approval from management.
  • Process bad debts in a timely fashion when claims are determined to be uncollectable. Document all reasons for uncollectability and efforts in the process.
Additional Responsibilities:
  • Apply third-party payments daily including checks, wire transfers, EFT payments, other bank deposits, cash, and credit card payments. Confirm completeness and accuracy of payment information to the residents' accounts.
  • Establish good relationships with all third-party payers with professional communications.
  • Efficiently conduct inquiries and analysis for resolution of discrepancies.
Requirements:
  • Two to three years of experience processing skilled nursing medical claims with third parties including Medicare, managed care, and insurance companies with a track record of successful collections.
  • One or more years of experience working in a high-volume, short-term rehab environment.
  • Knowledge of billing and related software preferred and/or experience with similar software.
  • Proficiency with Microsoft Office and ability to learn company IT systems.
Preferred Qualifications:
  • MatrixCare/Answers on Demand and Ability experience is a plus.
Essential Qualifications:
  • Strong communication, interpersonal, and organizational skills.
  • Detail orientation.
  • Ability to manage multiple priorities.
  • Discretionary judgment.
  • Ability to work independently and as part of a team.
Language Skills:
  • Ability to read, write, and speak English proficiently.

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