Medical Claims Analyst

11 hours ago

Ortigas, Philippines Risewave Consulting Inc. Full time ₱396,000 per year

Medical Claims Analyst

Shift: Night, M-F, 9pm-5am

Work Setup: Onsite (Ortigas, Pasig)

About the Role:

Our client is looking for a highly motivated and detail-oriented Medical Claims Analyst to join our team In this role, you will be responsible for the collection, account follow-up, billing, and allowance posting for assigned accounts, ensuring timely resolution of all outstanding claims.

Key Responsibilities:

  • Follow up with payers to resolve outstanding claims via phone, emails, fax, or websites.
  • Meet daily productivity and quality standards as set by departmental policies.
  • Use workflow systems, client host systems, and other tools for claims payment collection and resolution.
  • Adhere to policies and procedures while ensuring timely filing deadlines are met.
  • Research payer-specific billing guidelines as needed.
  • Identify and resolve payment delays, trends, and issues to reduce denials.
  • Initiate appeals and correct billing errors when necessary.
  • Understand under/overpayments and credit balance processes.
  • Assist with special A/R projects as needed.
  • Maintain patient confidentiality and adhere to HIPAA standards.

Qualifications:

  • Completed at least High School (Senior High) education.
  • Minimum of 1 year experience in Healthcare Accounts Receivable/Collections in a BPO setting or environment (including claims payment processing, claims status, medical billing, AR follow-ups, denials, and appeals).
  • Experienced under Provider side
  • Familiarity with Denial management (reasons of denials)
  • AR follow up experience
  • Familiar with Explanation of Benefits, Copay, Coinsurance and Deductibles.
  • Experience processing billing and payments

Job Type: Full-time

Pay: Up to Php33,000.00 per month

Benefits:

  • Health insurance
  • Opportunities for promotion

Application Question(s):

  • Please share your active Viber number and best time to call you.
  • What is your expected salary for this role?
  • This role requires working the night shift and being onsite for 5 days a week. Are you comfortable and amenable with these requirements?

Experience:

  • US Healthcare (claims, denials, medical billing, etc): 1 year (Required)

Work Location: In person

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