Claims SMEs

1 day ago

Taguig, National Capital Region, Philippines UST Full time ₱900,000 - ₱1,200,000 per year
  • 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
  • Review and address provider inquiries regarding claims, billing, and other RCM related issues

Qualifications:

  • Minimum of 3 years of experience in medical claims processing experience; SME/Lead/Trainer experience a strong advantage

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

  • Excellent verbal and written business communication skills
  • Strong attention to detail and the ability to make appropriate decisions based on information presented
  • Amenable to work nightshift, onsite (McKinley, Taguig) and 5 months contract

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