Arbitration Specialist

3 days ago

Cebu City, Central Visayas, Philippines EMAPTA Full time ₱1,200,000 - ₱2,400,000 per year

As an Arbitration Specialist, you will be responsible for reviewing, analyzing, and preparing claims eligible for arbitration in both ERISA/NSA and state insurance department claims. You'll collaborate with external vendors and arbitrators, ensuring accuracy and compliance while leveraging your expertise in medical collections.

Key Responsibilities:

  • Analyze claim reports to determine eligibility for arbitration (ERISA/NSA and state insurance claims).
  • Prepare and submit claims for arbitration through appropriate portals.
  • Reprioritize key tasks as needed and provide regular updates to the manager and director.
  • Collaborate with external vendors, including state insurance departments and arbitrators, for issue resolution.
  • Compile medical records and explanations of benefits into a formal document for arbitration submissions.
  • Meet KPI goals of processing 15-20 submissions per day.
  • Utilize Microsoft Excel for data analysis, including formulas, pivot tables, and filters.
  • Demonstrate proficiency in negotiation and technical writing.
  • Maintain professionalism in all communications, both internal and external.
  • Ensure compliance with medical terminology standards and industry regulations.

Qualifications:

  • Education: High school diploma or equivalent.
  • Experience: Minimum of 3 years in Medical Billing/Collections Management.
  • Skills & Knowledge: Proficiency in CPT codes and HIPAA regulations.
  • Strong knowledge of laws governing communication and privacy.
  • Excellent organizational, analytical, and problem-solving abilities.
  • Strong communication skills, both verbal and written.
  • Ability to maintain professionalism and adhere to attendance expectations.

Job Types: Full-time, Permanent

Application Question(s):

  • Willing to work onsite nightshift?
  • Do you have background in healthcare?

Work Location: In person

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