Medical Insurance Claims Resolution Specialist

1 week ago


Pasig, National Capital Region, Philippines Visaya KPO Full time

Visaya KPO is seeking an experienced Medical Insurance Claims Resolution Specialist to join our team. This role is responsible for ensuring the timely collection of outstanding government or commercial healthcare insurance receivables.

Job Description

We are looking for a highly skilled and organized individual to handle medical insurance claims from start to finish. The successful candidate will be responsible for verifying patient eligibility, obtaining authorization for healthcare services, and updating patient demographics and insurance information in our systems.

The ideal candidate will have excellent research skills, attention to detail, and the ability to work independently with minimal supervision. They will also be able to effectively communicate with payers, patients, and other stakeholders to resolve claims efficiently.

Responsibilities:
  • Verify patient eligibility and obtain authorization for healthcare services
  • Update patient demographics and insurance information in our systems
  • Conduct research and appropriately status unpaid or denied claims
  • Monitor claims for missing information, authorization, and control numbers (ICN/DCN)
  • Research EOBs for payments or adjustments to resolve claims
  • Contact payers by phone or through written correspondence to secure payment of claims
  • Access client systems for information regarding received payments, open claims, and other data necessary to resolve claims
  • Follow guidelines for prioritization, timely filing deadlines, and notation protocols within our systems
  • Secure medical documentation as required or requested by third-party insurance carriers
  • Obtain billing guidelines and requirements by researching provider billing manuals
  • Write appeal letters for technical appeals
  • Verify accuracy of underpayments by researching contracts and claims data
  • In the event of an authorization, coding, level of care, and/or length of stay denial, prepare claims for clinical audit processing
Requirements:

To be successful in this role, you will need:

  • A high school diploma or equivalent
  • 1-2 years of experience in medical insurance claims resolution or a related field
  • Excellent communication and organizational skills
  • Ability to work independently with minimal supervision
  • Strong research and analytical skills
  • Attention to detail and ability to meet deadlines
What We Offer:

We offer a competitive salary of $45,000 - $60,000 per year, depending on experience. Our benefits package includes health insurance, paid time off, and opportunities for professional growth and development.



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