Medical Claims Analyst

3 days ago

Pasig, National Capital Region, Philippines Comrise Full time ₱250,000 - ₱500,000 per year

Job Purpose:

  • The Medical Claims Analyst is responsible for collections, account follow up, billing and allowance posting for the accounts assigned to them.

Duties and Responsibilities:

  • Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or websites
  • Meets and maintains daily productivity/quality standards established in departmental policies
  • Adheres to the policies and procedures established for the client/team
  • Knowledge of timely filing deadlines for each designated payer
  • Performs research regarding payer specific billing guidelines as needed
  • Communicates to management any issues and/or trends identified
  • Initiate appeals when necessary
  • Send appropriate appeals, accurate requesting information, supporting documentation, and effective communication to complete recovery process
  • Understanding of under or over payments and credit balance processes
  • Assist with special A/R projects as needed. Analytical skills and the ability to communicate results are required
  • Use, protect and disclose patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
  • Understand and comply with Information Security and HIPAA policies and procedures at all times
  • Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Qualifications:

  • Completed at least High School education
  • Minimum 1 year of Healthcare Account Receivable/Collections in a BPO setting
    or environment (claims payments processing, claims status and tracking, Medical Billing, AR Follow ups, Denials and Appeals-outbound healthcare providers)
  • Experienced on medical billing/ AR Collections
  • Background in calling insurance (Payer) to verify claim status and payment dispute
  • Strong interpersonal skills, ability to communicate well at all levels of the organization
  • Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
  • High level of integrity and dependability with a strong sense of urgency and results oriented
  • Excellent written and verbal communication skills required
  • Gracious and welcoming personality for customer service interaction

Benefits:

  • Day 1 HMO with 2 of your dependents covered for FREE
  • Free Lunch Daily

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