Medical Claims Analyst

1 week ago

Pasig, National Capital Region, Philippines Risewave Consulting, Inc. Full time ₱900,000 - ₱1,200,000 per year

Job Purpose

The representative is responsible for collections, account follow up, billing and allowance posting for the accounts assigned to them.

Duties and Responsibilities

  • Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or websites.
  • Meets and maintains daily productivity/quality standards established in departmental policies.
  • Uses the workflow system, client host system and other tools available to them to collect payments and resolve accounts.
  • Adheres to the policies and procedures established for the client/team.
  • Knowledge of timely filing deadlines for each designated payer.
  • Performs research regarding payer specific billing guidelines as needed.
  • Ability to analyze, identify and resolve issues causing payer payment delays.
  • Ability to analyze, identify and trend claims issues to proactively reduce denials.
  • Communicates to management any issues and/or trends identified.
  • Initiate appeals when necessary.
  • Ability to identify and correct medical billing errors.
  • Send appropriate appeals, accurate requesting information, supporting documentation, and effective communication to complete recovery process.
  • Understanding of under or over payments and credit balance processes.
  • Assist with special A/R projects as needed. Analytical skills and the ability to communicate results are required.
  • Act cooperatively and courteously with patients, visitors, co-workers, management and clients.
  • Use, protect and disclose patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.

Qualifications

  • Completed at least High School education
  • With minimum 1 year of US Healthcare Account Receivable/Collections in a BPO setting or environment
    (claims payments processing, claims status and tracking, Medical Billing, AR Follow ups, Denials and Appeals-outbound healthcare providers)
  • Experienced on medical billing/ AR Collections.
  • Background in calling insurance (Payer) to verify claim status and payment dispute.
  • Must be amenable to work night shifts.
  • Must be amenable to work onsite in Ortigas, Pasig.

What's In It For You:

  • HMO on day 1 with dependent(s)
  • Free Lunch
  • Night differential
  • OT Pay
  • Incentives

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