Medical Claims Examiner

6 days ago

Sorsogon, Bicol, Philippines beBeeEligibility Full time ₱272,000 - ₱512,000
Medical Billing Professional

The Medical Billing Specialist role is pivotal in our healthcare team. This position oversees the monitoring of medical claims, conducts thorough investigations into rejections and denials, and ensures diligent documentation of related account activities.

This position requires a deep understanding of various eligibility requirements and payment methodologies, as well as a keen ability to accurately record contractual adjustments in compliance with government regulations and payer contracts.

Responsibilities:
  • Verify patient eligibility and benefits to ensure accurate coverage.
  • Review and submit claims in a timely manner while adhering to regulatory guidelines.
  • Obtain prior authorizations to support smooth claim approvals.
  • Monitor claim status and conduct A/R follow-up to ensure prompt payment.
  • Research and resolve claim rejections and denials, implementing measures to prevent future occurrences.
  • Generate and submit patient statements without interacting with patients.
  • Document all account activities accurately and in a timely manner.
  • Post manual payments, apply adjustments, and manage collections from various payers.
Qualifications:
  • At least 2 years of experience in revenue cycle processes, including eligibility verification, charge review, claims submission, AR follow-up, and denial management.
  • Experience with DME and Apero billing systems is preferred.
  • Candidates must demonstrate collaboration skills and adaptability in a fast-paced environment.

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