Senior Medical Billing Specialist

3 days ago

Ayala Alabang, National Capital Region, Philippines Gear Inc Full time

The ideal candidates will have at least 2 years of experience in medical billing, AR Calling, Denial Management or a related field and possess strong English proficiency. As part of our client-facing team, you will be providing vital support to client operations by ensuring accurate and compliant medical billing operations through outbound calling, data categorization, and transcript analysis.

Outbound Calling & Stakeholder Management

  • Lead outbound calls to insurance companies and payors to collect comprehensive information, including claim statuses, detailed denial reasons, payment discrepancies, and any required follow-ups.

  • Build and maintain professional relationships with external stakeholders to facilitate timely resolution of complex billing issues.

  • Ensure all communication is conducted in full compliance with client guidelines, healthcare regulations (e.g., HIPAA), and industry best practices.

Data Management, Categorization, and Reporting

  • Independently manage accurate recording, categorization, and labeling of data using client-defined taxonomy, ensuring alignment across teams.

  • Identify gaps or inconsistencies in data categorization and proactively propose improvements to enhance reporting quality and analysis efficiency.

  • Prepare and deliver detailed, structured reports and dashboards to the client at agreed frequencies, highlighting key trends and potential risks.

Advanced Call Transcript Analysis & Process Optimization

  • Review and analyze recorded call transcripts to extract actionable insights, identify denial trends, systemic issues, and patterns impacting claim outcomes.

  • Synthesize findings into comprehensive reports and present recommendations for process enhancements, contributing to the continuous improvement of billing and collection workflows.

  • Collaborate closely with internal teams and client representatives to implement agreed process changes and measure their effectiveness.

Mentorship & Knowledge Sharing

  • Provide guidance and support to junior team members in best practices for calling, data labeling, and analysis.

  • Contribute to the development of internal training materials and knowledge bases.

Qualifications:
  • Minimum of 2 years of experience in medical billing, insurance claims, or a related field.
  • Strong English proficiency, both verbal and written.
  • Familiarity with healthcare regulations and industry guidelines.
  • Excellent communication skills with the ability to make outbound calls to insurance companies and payors.
  • Detail-oriented and able to maintain accurate records.
  • Ability to work independently while adhering to internal guidelines and procedures.
  • Proficiency in Microsoft Office Suite or similar software; experience with medical billing software is a plus.

Additional Information:

This is a full-time position, and the successful candidate will work closely with the clients team to support their AI-powered platform in improving medical billing operations. The role offers an opportunity for professional growth and development within a dynamic, technology-driven environment.

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