Claims Analyst

1 week ago

Manila, National Capital Region, Philippines Health Business Solutions Full time

Job Summary:

We are seeking a detail-oriented and experienced Insurance Denials Management Specialist to join our team, specializing in hospice claims. The ideal candidate will have a strong background in analyzing, appealing, and resolving insurance denials to optimize reimbursement and ensure compliance with hospice care billing regulations.

Key Responsibilities:

  • Review, analyze, and manage insurance claim denials specifically related to hospice care services.
  • Identify root causes of claim denials and develop effective strategies for appeal and resolution.
  • Prepare and submit timely and accurate appeals to insurance payers, including Medicare, Medicaid, and private insurers.
  • Collaborate closely with billing, clinical, and coding teams to ensure accurate documentation and coding compliance for hospice claims.
  • Monitor denial trends and report findings to management to improve revenue cycle processes.
  • Maintain up-to-date knowledge of hospice billing regulations, payer policies, and industry best practices.
  • Track and document all denial management activities in the appropriate systems.
  • Communicate effectively with insurance companies, internal departments, and external providers to expedite claim resolutions.
  • Assist in training staff on hospice-specific denials management processes and requirements.
  • Contribute to process improvement initiatives to reduce denial rates and accelerate payment cycles.

Qualifications:

  • Minimum of 2 years experience in insurance denials management with a focus on hospice claims.
  • In-depth understanding of hospice billing, coding (including ICD-10, CPT, and HCPCS), and regulatory requirements.
  • Familiarity with Medicare Hospice Benefit and payer-specific policies.
  • Strong analytical and problem-solving skills.
  • Excellent written and verbal communication skills.
  • Proficient in denial management software, billing systems, and MS Office applications.
  • Ability to work independently and as part of a team in a fast-paced environment.
  • Detail-oriented with strong organizational skills.

Preferred:

  • Certification in Medical Billing, Coding, or Revenue Cycle Management (e.g., CPC, CPB) a plus.
  • Experience working with electronic health record (EHR) systems and hospice-specific billing platforms.
  • Knowledge of compliance and audit requirements related to hospice care claims.

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