Follow-Up Claims Specialist

11 hours ago

Manila, National Capital Region, Philippines beBeeMedical Full time ₱500,000 - ₱1,000,000

We are seeking a skilled Medical Claim Specialist to join our team. If you have experience with insurance reimbursement and medical claims processing, this could be the perfect opportunity for you.

Key Responsibilities
  1. Maximize Insurance Reimbursement: Our ideal candidate will have a proven track record of maximizing insurance reimbursement for healthcare providers.
  2. Claim Denial Resolution: You will work closely with insurance carriers to resolve denied claims, underpayments, or delayed processing issues.
  3. Insurance Carrier Interactions: Regular interactions with US-based insurance carriers will be required to follow up on unpaid claims and delayed processing.
  4. Claim Appeal Process: You will plan and execute the medical insurance claim denial appeal process to ensure timely payment.
  5. Client Communication: Excellent communication skills will be essential in interacting with US-based practice owners and clinicians to complete and correct any missing or incorrect data on their insurance claims.
Required Skills and Qualifications
  1. Minimum 6 Months Experience: A minimum of 6 months of experience in US-based AR follow-up and charge and payment posting is required.
  2. Education: A college degree in Computer Engineering, Mathematics, or similar field is preferred.
  3. Data Analysis: Hands-on experience with data analysis and data classification is necessary.
  4. Analytical Skills: Good analytical skills will be essential in resolving complex claim issues.
  5. US Medical Industry Knowledge: Familiarity with the US medical insurance industry and insurance claims processing cycle is required.
  6. ICD-10, CPT, HCPC: Knowledge of ICD-10, CPT, and HCPC coding systems is necessary.
  7. CMS-1500, UB-04: Understanding of CMS-1500 and UB-04 claim formats is required.
  8. Vericle Software: Experience with Vericle Software is an advantage.
  9. Soft Skills: Excellent listening, communication, and problem-solving skills are essential. Self-motivation and the ability to work autonomously are also necessary.
  10. Specialties: Experience working with chiropractic, physical therapy, and mental/behavioral health specialties is desirable.
Mandatory Requirements
  1. Eastern Time Zone: High comfort level working on Eastern Time Zone/US Shift is required.
  2. Internet Access: Good internet access at home is necessary.
  3. Mobile Hotspot: A mobile hotspot is required.
  4. Laptop/Desktop: A laptop/desktop with at least 8 GB of RAM is necessary.

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