Accounts Receivable Specialist

AddForce Human Resources Solution Inc.; Muntinlupa; On-site; PHP 279,000 - 390,600; Full time

Job summary

A leading human resources solution provider in Metro Manila is seeking a dedicated professional to handle healthcare claims management. This role requires at least 2 years of experience in a Healthcare BPO setting, strong communication abilities, and knowledge of insurance payer requirements. Responsibilities include monitoring outstanding accounts, managing denial resolutions, and ensuring timely payment collections. Candidates must be amenable to onsite work in Alabang, Muntinlupa City and understand the needs of various insurance entities.

Qualifications

• Must have 2+ years of experience in a Healthcare BPO setting.
• Knowledge of commercial, HMO, Medicare/Medicaid, and other payer requirements.
• Proficient knowledge of medical terminology encountered in medical claims denials.

Responsibilities

• Monitor outstanding accounts to ensure timely collection of payments.
• Maintain accurate aging reports for all outstanding invoices.
• Contact insurance companies, clients, or customers to check claim status or payment status.
• Investigate claim denials and underpayments.
• Provide clear and respectful communication to clients or insurers.

Skills

Effective communication abilities

Proven problem-solving skills

Education

Graduate of any college degree

Tools

KAREO

Availity

Optum

Medicare

Evicore portals

Job description

Requirements:

• Graduate of any 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
• Proven problem-solving skills
• Proficient knowledge of medical terminology is likely to be encountered in medical claims denials.
• Amenable to work onsite during training and nesting period in Alabang, Muntinlupa City and US shifts

Responsibilities

• Monitor outstanding accounts to ensure timely collection of payments.
• Maintain accurate aging reports for all outstanding invoices.
• Prioritize accounts based on age, value, or client-specific requirements.
• Follow-Up on Outstanding Claims/Invoices
• Contact insurance companies, clients, or customers via phone, email, or portals to check claim status or payment status.
• Identify delays, denials, or issues affecting payment.
• Document all follow-up actions in the system.
• Denial Management & Resolution
• Investigate claim denials and underpayments.
• Work with billing teams to correct and resubmit claims.
• Appeal denied claims with proper documentation when necessary.
• Payment Posting Support
• Coordinate with payment posting teams to verify payment accuracy.Resolve discrepancies between posted payments and expected reimbursements.
• Communication & Coordination
• Collaborate with billing, coding, and customer service teams to resolve issues.
• Communicate with insurance providers or clients to clarify requirements or missing information.
• Customer Service
• Provide clear and respectful communication to clients or insurers.
• Address inquiries related to billing or outstanding balances.
• Process Improvement
• Identify frequent denial trends or process bottlenecks.
• Suggest improvements to reduce AR days and denial rates.