Sr. BPM Associate

2 days ago

Taguig, National Capital Region, Philippines UST Full time $40,000 - $60,000 per year
Job Description:
  • 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
  • Determine accurate payment criteria for clearing pending claims based on defined policies and procedures
  • Research 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, and other Claims matters
  • Assist and/or communicate with providers to fully understand issues and complexities of claims cases
  • Demonstrate ability to work on high volume of repetitive claims
  • Demonstrate increasing productivity to meet minimum requirements while maintaining quality standards
  • Ready to work on a fast-paced learning process and highly engaged to complete all claims cases assigned
Education and experience:
  • Bachelor's Degree holder preferably in the field of Nursing, Healthcare and Allied Medical Profession
  • Minimum of 2 years of experience in medical claims processing experience
  • Knowledge in medical coding, diagnosis coding and terminologies an advantage but not required
Skillset:
  • Proficient knowledge on US Healthcare Practice, Medical Coding (ICD-10, CPT4, DRG, HCPCS), Clinical Documentation Improvement, medical terminologies, EDI, and HIPAA protocols are a must
  • Ability to multi-task and follow documented claims processes with minimal supervision
  • Excellent verbal and written business communication skills
  • Proficiency in Windows OS and Microsoft Office applications, particularly in Excel
  • Strong attention to detail and the ability to make appropriate decisions based on information presented
Skills:About Company:

UST

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