ar follow up specialist

1 week ago

Ayala Alabang, National Capital Region, Philippines ADEC INNOVATIONS HEALTHCARE, INC Full time ₱900,000 - ₱1,200,000 per year

JOB SUMMARY

We are seeking a detail-oriented and results-driven professional to support the financial integrity of our organization through the accurate and timely recovery of outstanding medical claims. The ideal candidate will bring strong analytical capabilities, exceptional communication skills, and in-depth knowledge of insurance claims processes. This role is instrumental in optimizing revenue cycle performance and ensuring compliance with payer requirements.

JOB RESPONSIBILITIES

1.     Review and resolve outstanding claim accounts from worklists or management direction, focusing on denied claims across various payers and regions.

2.     Analyze account history and conduct in-depth research, including review of patient charts and encounter documentation, to support resolution.

3.     Investigate and follow up on denied claims, identifying causes related to coding discrepancies or contract issues. Prepare and attach appropriate documentation, gather additional information, and submit corrected claims to facilitate accurate and timely adjudication.

4.     Initiate and manage appeals for denied claims by researching root causes, collecting necessary documentation, making necessary account adjustments, and resubmitting claims. Maintain follow-up activities to ensure final resolution.

5.     Communicate claim issues and denial trends to leadership and contribute to continuous process improvement.

6.     Identifies, researches, and ensures timely processing of payments and error corrections, ensuring appropriate documentation of payments, allowances, denial, rejections, are recorded on individual accounts

7.     Review remittance advice and investigate underpayments or overpayments.

8.     Perform additional A/R tasks and support other departmental responsibilities as assigned.

9.  Reports security incidents and/or any identified security weaknesses.

10.  Performs other tasks that may be assigned from time to time.

JOB REQUIREMENTS

  • Graduate of any 4year college degree
  • Must have 2+ years in a Healthcare BPO setting
  • Knowledge of commercial, HMO, Medicare/Medicaid, and other payer requirements.
  • Working knowledge on the use of insurance payer websites ie: Availity, Optum, Medicare, Evicore portals.
  • Working knowledge with Practice Management systems, preferably KAREO a plus.
  • Effective communication abilities with and not limited to team members outside clients and patients.
  • Proven problem-solving skills. The ability to research and resolve complex insurance denials while obtaining a clear understanding to present actionable solutions.
  • Proficient knowledge of medical terminology is likely to be encountered in medical claims denials.
  • Denial management experience is a plus

PERKS OF JOINING US

  • Competitive Salary
  • Hybrid arrangement (Training and nesting period is ONSITE-Alabang)
  • HMO on Day1 with FREE ONE DEPENDENT***
  • 15% Night Differential
  • US Shifts
  • Free Shuttle
  • Employee referral bonus
  • Employee engagements
  • Healthy working environment
  • Free webinars and internal trainings/events and more

Office Location: Alabang Corporate Center

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