Medical Billing Claims Specialist

7 days ago

Iloilo City, Western Visayas, Philippines Caring One Iloilo Inc Full time ₱200,000 - ₱240,000 per year

Position Summary

The Billing Claims Specialist is responsible for the accurate and timely processing of medical claims, including charge entry, denial management, and appeals. This role ensures outstanding and past-due claims are resolved, maintains compliance with payer and regulatory requirements, and provides support to patients with billing inquiries. The specialist serves as a key liaison between patients, payers, and internal teams to drive efficient reimbursement and positive patient experiences.

Key Responsibilities

Claims & Charge Entry

  • Enter and validate daily charges and claims with accuracy in patient demographics, CPT/ICD codes, modifiers, insurance details, and required authorizations.
  • Identify and correct errors or missing information prior to submission to minimize rejections.

Denials & Claims Management

  • Monitor and correct front-end rejections for immediate resubmission.
  • Review denied claims, determine causes, and prepare appeals or corrected claims.
  • Track pending and past-due claims; follow up with payers to secure payment.
  • Ensure all claims are submitted within timely filing limits.
  • Investigate and follow up on unpaid claims, underpayments, and recoupments.

Patient Support

  • Respond to patient questions regarding statements, balances, and insurance coverage.
  • Provide clear and professional communication to ensure a positive patient experience.

Compliance & Documentation

  • Ensure claims comply with payer guidelines, insurance policies, and regulatory standards.
  • Maintain detailed documentation for appeals, corrections, and supporting materials.
  • Protect patient confidentiality and adhere to HIPAA requirements.

Job Type: Full-time

Pay: From Php20,000.00 per month

Benefits:

  • Opportunities for promotion
  • Paid training

Work Location: In person

  • Claims Resolution Specialist

    2 days ago

    Iloilo City, Western Visayas, Philippines Kavi Global Full time

    As part of the Tech Enabled Services (TES) Team of Kavi Philippines, the Claims Resolution Specialist contacts patients, employees, attorney representatives, and other responsible parties to gather information related to collecting payments for complex claims. The Claims Resolution Specialist acts as the liaison between key Client contacts and end...

  • Claims Processing Executive

    2 days ago

    Iloilo City, Western Visayas, Philippines JBW Managed Consulting and Services Full time ₱250,000 - ₱350,000 per year

    As part of the Tech Enabled Services (TES) Team of Kavi Philippines, the Claims Resolution Specialist contacts patients, employees, attorney representatives, and other responsible parties to gather information related to collecting payments for complex claims. The Claims Resolution Specialist acts as the liaison between key Client contacts and end...

  • Insurance Verification Specialist

    2 weeks ago

    Iloilo City, Western Visayas, Philippines Boji Medical Billing Full time ₱360,000 - ₱432,000 per year

    Insurance Verification Specialist (BPO) — Dental ServicesRemote — Philippines Full-Time, Individual ContributorJob SummaryHenry Schein One is seeking a detail-oriented Insurance Verification Specialist to joinour remote Business Process Outsourcing (BPO) team in the Philippines. You will contactU.S. dental insurance payers via phone to obtain accurate...

  • Claims Resolution Specialist

    2 days ago

    Iloilo City, Western Visayas, Philippines JBW Managed Consulting and Services Full time ₱204,000 - ₱300,000 per year

    FRESH GRADUATE ARE WELCOME TO APPLYResponsibilities:● Contact end patients and their employers and attorney representatives in the US to gather information to complete the claim.● Analyze and evaluate complex claims payments using end Client's proprietary software, systemsand tools.● Use payment documentation provided by payers to determine if the...

  • Healthcare Billing Specialist

    2 days ago

    Cebu City, Central Visayas, Philippines Tahche Outsourcing Services Full time $15,000 - $30,000 per year

    Our US partner is one of the leading Medical Digital Imaging Service Providers in New Jersey. They offer a full spectrum of diagnostic imaging services in comfortable, convenient, and friendly outpatient imaging centers.As a Healthcare Billing Specialist, you will be catering to all billing inquiries from patients and doctors, processing payments, and...

  • Clinical Program Nurse I

    2 days ago

    Iloilo City, Western Visayas, Philippines Crawford & Company Full time ₱180,000 - ₱250,000 per year

    Responsible for auditing in-patient and/or surgical bills to promote excellence in medical bill review and process improvement.Medical Bill ReviewProcesses inpatient and/or surgical bills by adhering to the given standard operating procedures (SOP) and turnaround time to complete the task.Performs bill review process by utilizing appropriate...

  • Clinical Program Nurse I

    2 days ago

    Iloilo City, Western Visayas, Philippines Crawford Full time ₱900,000 - ₱1,200,000 per year

    DescriptionResponsible for auditing in-patient and/or surgical bills to promote excellence in medical bill review and process improvement.ResponsibilitiesMedical Bill ReviewProcesses inpatient and/or surgical bills by adhering to the given standard operating procedures (SOP) and turnaround time to complete the task.Performs bill review process by utilizing...

  • Assistant Manager

    2 weeks ago

    Iloilo City, Western Visayas, Philippines JBW Managed Consulting and Services Full time ₱500,000 - ₱600,000 per year

    Position Title: Claims Resolution SpecialistLocation: Iloilo City, PhilippinesEmployment Type: Full-Time (On-site)OverviewWe are hiring experienced professionals to join our healthcare claims processing team as Assistant Managers. In this role, you will support the Call Center Operations Manager and help lead a team of approximately 25 Claim Resolution...

  • RCM Supervisor

    2 days ago

    Iloilo City, Western Visayas, Philippines JBW Managed Consulting and Services Full time

    Position Title: Claims Resolution SpecialistLocation: Iloilo City, PhilippinesEmployment Type: Full-Time (On-site)OverviewWe are hiring experienced professionals to join our healthcare claims processing team as Assistant Managers. In this role, you will support the Call Center Operations Manager and help lead a team of approximately 25 Claim Resolution...

  • Clinical Program Nurse II

    1 week ago

    Iloilo City, Western Visayas, Philippines Crawford & Company Full time ₱900,000 - ₱1,200,000 per year

    Responsible for reviewing medical information to determine if requested treatment is medically necessary and appropriate according to the given standards.Evaluation of Medical InformationAnalyzes medical information and applies established criterion to facilitate the utilization review process.Collaborates objectively with peer physicians to facilitate case...