Medical Billing Specialist - AR

Position Summary:

The Medical Billing Specialist - AR will play a vital role in our financial team with the primary responsibility of handling all aspects of claims management, from investigation to resolution. This involves reviewing and analyzing the status of claims, navigating various online portals, and regularly communicating with payers. The position also requires a proactive approach towards the investigation and analysis of claim denials, finding effective solutions to ensure their payment, and consistently following up on any outstanding claims. The Accounts Receivable Specialist will report directly to the Accounts Receivable Supervisor/Manager and contribute to the effective and efficient operation of our financial management system.

Job Details:

• Work from home
• Monday to Friday | 9 PM to 6 AM
• *Following Philippine Holidays

Responsibilities:

• Navigate Different Online Portals: Regularly access various online systems to check the status of claims, ensuring they are processed correctly and in a timely manner.
• Communicate with Payers: Contact payer hotlines for inquiries, clarifications, and the status of claims. Display professionalism and efficiency in all interactions to maintain positive relationships.
• Investigate Claim Denials: Proactively investigate the reasons behind claim denials, analyze the information gathered, and develop effective solutions to ensure claim payments.
• Manage Claim Adjustments: Resubmit claims, request reprocessing, send corrected claims, and/or create appeals as needed, based on analysis and investigation results.
• Follow Up on Outstanding Claims: Diligently and promptly follow up on any open and unpaid claim until the Accounts Receivable list is cleared up, preventing untimely resubmission or appeal.
• Report Regularly: Provide daily reports to the Accounts Receivable Supervisor/Manager about completed tasks and any pending issues, ensuring clear and concise communication about any updates or issues that require attention.
• Maintain the Accounts Receivable System: Regularly update the Accounts Receivable system with clear, comprehensive notes to track progress and facilitate efficient claim management.

Qualifications:

• At least 3 years’ experience in an accounts receivable role, with a focus on healthcare claims management.
• Excellent ability to navigate and use various online systems and portals.
• Strong communication skills, both verbal and written, for effective liaison with payers and internal stakeholders.
• Proven analytical and problem-solving skills, with the ability to analyze claim denials and devise effective resolutions.
• Attention to detail and high levels of accuracy in all tasks.
• Ability to work effectively under pressure and manage multiple priorities.
• Proficient in using accounts receivable software and other standard office software such as Microsoft Office.