Medical Billing Claims Specialist

1 week 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

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