Clinical Denials Specialist

1 day ago


Pasig, National Capital Region, Philippines Visaya KPO Full time
Job Title: AR Complex Clinical Denials Specialist

At Visaya KPO, we are seeking a highly skilled and experienced AR Complex Clinical Denials Specialist to join our team.

Key Responsibilities:
  • Verify and obtain eligibility and/or authorization using payer websites, client eligibility systems, or via phone with insurance carriers/providers.
  • Update patient demographics/insurance information in appropriate systems.
  • Research and 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.
  • Contacts payers via phone or written correspondence to secure payment of claims; reconsideration and appeal submission.
  • Access client systems for payment, patient, claim, and data information.
  • Follow guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systems.
  • Secure needed medical documentation required or requested by third-party insurance carriers.
  • Maintain and respect the confidentiality of patient information in accordance with insurance collection guidelines and corporate policy and procedure.
Requirements:
  • 3+ years of medical collections, denials, and appeals experience.
  • At least 6 months of EPIC tool experience.
  • Experience with all but not limited to the following denials: DRG downgrades, level of care, coding, medical necessity.
  • Intermediate knowledge of ICD-10, CPT, HCPCS, and NCCI.
  • Intermediate knowledge of third-party billing guidelines.
  • Intermediate knowledge of billing claim forms (UB04/1500).
  • Intermediate knowledge of payor contracts - commercial and government.
  • Intermediate working knowledge of Microsoft Word and Excel.
  • Intermediate knowledge of health information systems (i.e. EMR, Claim Scrubbers, Patient Accounting Systems, etc.).
  • Intermediate knowledge of DDE Medicare claim system.
  • Intermediate knowledge of government rules and regulations.
Perks and Benefits:
  • 15% Night Differential.
  • HMO Benefits after 30 days + Add Up to 2 Dependents.
  • Retirement Benefits.
  • 24 Leave Credits per year, Convertible to Cash.
  • Wholistic Employee Wellness Program.

Job Type: Full-time



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