Customer Service Representative

9 hours ago

Pasig, National Capital Region, Philippines Risewave Consulting, Inc. Full time ₱250,000 - ₱500,000 per year

Job Purpose

The Medical Claims Analyst is responsible for collections, account follow-up, billing, and allowance posting for assigned accounts. The role ensures accurate, timely resolution of outstanding claims through proactive follow-up and analytical problem-solving.

Duties and Responsibilities

  • Follow up with payers via phone, email, fax, or payer portals to ensure timely resolution of outstanding claims.
  • Meet and maintain daily productivity and quality standards.
  • Use workflow systems, client host systems, and other tools to collect payments and resolve accounts.
  • Adhere to all client and team policies and procedures.
  • Maintain knowledge of timely filing deadlines for designated payers.
  • Research payer-specific billing guidelines as needed.
  • Analyze and resolve issues causing payer payment delays.
  • Identify trends in claim issues to proactively reduce denials.
  • Communicate identified issues and trends to management.
  • Initiate and process appeals when necessary.
  • Identify and correct medical billing errors.
  • Prepare and send accurate appeal documentation and supporting records.
  • Understand underpayments, overpayments, and credit balance processes.
  • Assist with special A/R projects as needed; strong analytical and communication skills required.
  • Maintain cooperative and courteous communication with patients, visitors, coworkers, management, and clients.
  • Protect and handle PHI in accordance with HIPAA standards.
  • Work independently using assigned work queues.
  • Maintain confidentiality and professionalism at all times.
  • Perform other duties as assigned by management.

Qualifications

  • Completed at least High School education.
  • Minimum of 1 year of Healthcare Accounts Receivable/Collections experience in a BPO environment (claims payment processing, status/tracking, medical billing, AR follow-ups, denials, appeals).
  • Experience in medical billing and AR collections.
  • Background in calling insurance payers to verify claim status and resolve payment disputes.
  • Must be willing to work night shifts.

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