Medical Claims Specialist

11 hours ago


Pasig, National Capital Region, Philippines Visaya Knowledge Process Outsourcing Full time
Job Summary

We are seeking a highly skilled Medical Claims Specialist to join our team at Visaya Knowledge Process Outsourcing. As a key member of our healthcare accounts receivable team, you will be responsible for verifying patient eligibility, obtaining authorizations, and resolving claims denials.

Key Responsibilities
  • Verify patient eligibility and obtain authorizations through payer websites, client systems, or phone calls with insurance carriers
  • Update patient demographics and insurance information in relevant systems
  • Research and resolve unpaid or denied claims
  • Monitor claims for missing information, authorization, and control numbers
  • Research EOBs for payments or adjustments to resolve claims
  • Communicate with payers via phone or written correspondence to secure payment of claims
  • Access client systems for payment, patient, claim, and data information
  • Follow guidelines for prioritization, timely filing deadlines, and notation protocols
  • Secure medical documentation required by third-party insurance carriers
  • Maintain patient confidentiality in accordance with insurance collection guidelines and corporate policy
Requirements
  • 2-3 years of experience in medical collections, denials, and appeals
  • At least 6 months of experience with the EPIC tool
  • Intermediate knowledge of ICD-10, CPT, HCPCS, and NCCI
  • Intermediate knowledge of third-party billing guidelines and billing claim forms (UB04/1500)
  • Intermediate working knowledge of Microsoft Word and Excel
  • Intermediate knowledge of health information systems (EMR, claim scrubbers, patient accounting systems)
Preferred Requirements
  • Intermediate knowledge of patient accounting systems (EPIC, Cerner, STAR, Meditech, CPSI, Invision, PBAR, All Scripts, or Paragon)
  • Intermediate knowledge of the DDE Medicare claim system
  • Intermediate knowledge of government rules and regulations
Work Environment

This is an onsite position located in Ortigas, Pasig City.



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