Medical Collections Specialist

3 hours ago

Carmen Misamis Oriental, Philippines Clinovation Corp. Full time $30,000 - $60,000 per year
Job Summary

Clinovation Corp, a call center and business associate of a US-based medical group, is looking for a Medical Collections Specialist to join our Revenue Cycle Management team. This role focuses on accurate claim repricing, payer negotiation, and collections follow-ups to ensure maximum reimbursement. The ideal candidate has a solid background in medical billing, deep understanding of payer rules, and sharp attention to detail.


Key Responsibilities

Repricing & Collections

  • Review medical claims for accuracy and ensure they follow payer contracts and fee schedules.
  • Identify reimbursement discrepancies and initiate corrective actions such as adjustments or appeals.
  • Monitor underpaid or incorrectly paid claims and resolve issues through follow-up and negotiation.
  • Coordinate with insurance payers to negotiate payment rates for out-of-network claims when applicable.
  • Stay updated on payer-specific rules, regulations, and fee schedule updates.

Revenue Optimization

  • Analyze collection and repricing trends to identify workflow improvement opportunities.
  • Collaborate with the Billing Manager to refine claim management policies.
  • Develop strategies to minimize denials and maximize reimbursement.

Documentation & Communication

  • Maintain detailed records of payer communications, adjustments, and resolutions.
  • Prepare and distribute reports summarizing collection performance, trends, and outstanding issues.
  • Coordinate with US-based teams and payers to resolve disputes professionally.

Compliance

  • Ensure all repricing and collection activities comply with federal, state, and payer regulations, including HIPAA.
  • Conduct periodic audits of repriced claims for accuracy and compliance.

Qualifications

Education & Experience

  • High school diploma or equivalent required; associate's or bachelor's degree preferred.
  • Minimum of 2–3 years of experience in medical billing, collections, or payer negotiations, ideally in a provider-side or healthcare BPO setting.

Skills & Competencies

  • Proficiency in medical billing systems (e.g., Kareo, AdvancedMD, or similar).
  • Strong understanding of CPT and ICD-10 coding and payer fee schedules.
  • Excellent negotiation and problem-solving skills.
  • Strong analytical ability and keen attention to detail.
  • Effective verbal and written communication skills.
  • Ability to multitask and meet deadlines in a fast-paced environment.

Certifications (Preferred but Not Required)

  • Certified Professional Biller (CPB) or Certified Professional Coder (CPC).

What We Offer
  • Company-covered government contributions - no deductions on salary (SSS, PhilHealth, Pag-IBIG).
  • Paid time off and holiday pay.
  • Opportunities for upskilling and career advancement.

Equal Opportunity Employer

Clinovation Corp is an equal opportunity employer. We celebrate diversity and are committed to maintaining an inclusive, collaborative workplace.

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