AR Follow-up Representative

2 days ago

Quezon City, National Capital Region, Philippines Tenet Global Business Center, Inc. Full time ₱900,000 - ₱1,200,000 per year

Responsibilities:

  • Timely follow-up and resolution on all outstanding A/R including unpaid/underpaid/denied claims for all payers including self-pay to obtain maximum reimbursement.

  • Manage daily work queue to prioritize high dollar claim balances.

  • Review & work incoming insurance and patient correspondence including refund requests.

  • Send appeals when appropriate or provide the requested medical documentation.

  • Ability to review medical documentation to justify medical necessity.

  • Review patient balances to ensure accuracy and follow up with patients to obtain payments.

  • Take incoming patient phone calls to resolve inquiries, billing issues, or outstanding balances.

  • Review insurance payments and determine accuracy of reimbursement based on contracts, fee schedules or summary plan documents.

  • Leverage knowledge of Medicare, state Medicaid, and local coverage determinations (LCD's) for claim resolution.

  • Negotiate payment amounts for procedures with Third Party Administrators for out of network providers.

  • Recommend an adjustment when applicable or recommend a refund for overpayments to insurance carriers or patients, providing the appropriate documentation.

Requirements:

  • 2+ years of ASC revenue cycle OR orthopedic collections experience.

  • Ability to read and interpret insurance explanations of benefits and managed care contracts.

  • Must communicate effectively, both verbally and in writing, with internal and external clients.

  • Must be able to multi-task and handle competing priorities while meeting or exceeding deadlines

  • Knowledge or experience working with a variety of health care insurance payers is preferred

  • Intermediate computer proficiency in Microsoft Office including Excel and Outlook

  • Advantx, Vision, HST, Waystar experience preferred.

  • High School Diploma or equivalent.

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