Billing Specialist

2 weeks ago

Manila, National Capital Region, Philippines DME Service Solutions Full time ₱25,000 - ₱50,000 per year

About DME:

We are DME, a healthcare BPO leader delivering customized, HIPAA-compliant workforce solutions that enhance productivity and customer experiences. Driven by our core values, we help companies across industries understand customer needs and develop innovative solutions. Our mission is to enhance our clients' brand value through positive customer experiences while achieving strategic business goals.

At DME Service Solutions, diversity, equity, and inclusion are more than words—they define who we are. Our commitment to these values is unwavering, and our agents are dedicated to serving communities from all backgrounds. Innovation and integrity are at the heart of our business philosophy. Our employees enjoy a world-class experience and benefits, which they extend to their service for our clients and their customers. We are dedicated to supporting the healthcare industry, partnering with biotech companies, healthcare systems, medical device manufacturers, and medical supply distributors. If you believe in business as a force for good and in companies doing well while doing good, you've come to the right place.

Job Brief:

As Billing Specialist, responsible for the completion of all tasks and duties required of a Medical Biller. These administrative and billing tasks are vital in ensuring our patients are billed accurately. This role is critical in maintaining patient satisfaction and operational success at our multiple clinics throughout the US from a central location.

Key Responsibilities:

Duties and Responsibilities:

  • Maintain patient confidentiality and comply with HIPAA regulations.
  • Review Explanation of Benefits (EOBs) and electronic remittance advice (ERA) for accuracy, post payments, and address denials.
  • Prepare and submit accurate professional claims to insurance companies, government payers, or third-party payers.
  • Accurately execute claim processing tasks by following detailed project instructions.
  • Identify and resolve billing errors, underpayments, or overpayments.
  • Update and maintain accurate patient billing records.
  • Communicate with payers to verify claim status, resolve disputes, and obtain necessary documentation.

Job Required Qualification:

  • 3 to 5 years of US Healthcare experience with the knowledge and skills required
  • 3 years experience of professional claim billing preferred but not required
  • 3 years experience AR experience in a healthcare setting required.
  • Knowledge of billing processes, insurance guidelines, and healthcare terminology.
  • Advanced proficiency in EOB analysis for claim denial management and payment posting
  • Experience with billing software and electronic health records (EHR) systems.
  • Strong attention to detail and accuracy.
  • Excellent communication and problem-solving skills.
  • Understanding and validation of patient eligibility, knowledge of CPT codes, DX codes, NPI

numbers, Revenue codes, and Provider Tax IDs.

  • Proficient in Denial and Rejection handling
  • Experience to handle Multiple Providers' Claims,
  • Experience handling Medicare and Medicaid Claims – Establishing patient eligibility, Coordination of Benefits (COB), knowledge of Primary Rules and Determinations, knowledge of Independent Practice Associate (IPA), etc
  • Knowledge of all Provider types – such as, Billing Provider, Referring Provider, Rendering Provider etc.
  • Knowledge of Medical Terminology, Basic Anatomy and Physiology
  • Ability to multi-task with all the above
  • Must have the ability to remain focused and calm during stressful situations
  • Possess strong organizational skills and prioritization
  • Ability to work independently and meet deadlines.

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