Associate BPM Lead

19 hours ago

Taguig, National Capital Region, Philippines UST Full time

6 Openings

Taguig City

Role description

Responsible for the accurate processing and completion of medical claims based on defined guidelines and policies.

  • Process new claims or modifies existing claims according to the appropriate and applicable action

  • Analyze claims to determine appropriate action to approve or deny a claim for payment

  • Determines accurate payment criteria for clearing pending claims based on defined policies and procedures

  • Researches claims edits to determine appropriate benefit application utilizing established criteria, applies physician contract pricing as needed for entry-level claims

  • Reviewing and addressing provider inquiries regarding claim adjudication

  • Understand and apply knowledge and various medical claims forms to the claims process

  • Demonstrate ability to work on high volume of claims

  • Demonstrate increasing productivity to meet minimum requirements while maintaining quality standards

QUALIFICATIONS:

Education

  • Bachelor's degree in Nursing / Healthcare an advanatage but not required

  • Credential/Professional Certification related to current work is an advantage

Work Experience

  • Has at least 2 years of medical claims processing experience

Skillset

  • Proficient knowledge on US Healthcare Practice, Medical Coding (ICD-10, CPT4, DRG, HCPCS), Clinical Documentation Improvement, medical terminologies, EDI, and HIPAA protocols

  • Ability to multi-task and follow documented claims processes with minimal supervision

  • Excellent verbal and written business communication skills required

  • Strong proficiency in Windows OS and Microsoft Office applications, particularly Excel

  • Strong attention to detail and the ability to make appropriate decisions based on information presented

Skills

medical claims processing,hipaa,claims adjudication,us healthcare,ms office

About UST

UST is a global digital transformation solutions provider. For more than 20 years, UST has worked side by side with the world's best companies to make a real impact through transformation. Powered by technology, inspired by people and led by purpose, UST partners with their clients from design to operation. With deep domain expertise and a future-proof philosophy, UST embeds innovation and agility into their clients' organizations. With over 30,000 employees in 30 countries, UST builds for boundless impact—touching billions of lives in the process.

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