AR Denials & Appeals Specialist

ADEC Innovations; Muntinlupa; On-site; PHP 350,000 - 550,000; Full time

Benefits offered by this job

Competitive salary

Onsite at Alabang Corporate Center

Free shuttle

15% Night Differential

HMO DAY1 with dependent

Sleeping quarters with lactation room

Employee referral bonus

Employee engagements

Healthy working environment

Free webinars and trainings

Job summary

ADEC Innovations in the Philippines seeks a detail-oriented RCM AR professional to support the recovery of outstanding medical claims. The role emphasizes analytical research, communication, and adherence to payer requirements to optimize revenue cycle performance.

You will review denied claims, investigate root causes, and collaborate with teams to ensure accurate adjudication and timely payments. The position is on-site in Alabang with US shifts.

Qualifications

• Bachelor's degree in any 4-year program.
• Minimum 2+ years of RCM AR experience in Healthcare BPO.
• Knowledge of payer requirements (Commercial, HMO, Medicare/Medicaid).
• Proficient use of payer portals (Availity, Optum, Medicare, Evicore).
• Excellent communication and problem-solving skills.

Responsibilities

• Review and resolve outstanding claim accounts from worklists, focusing on denied claims.
• Analyze account history and review documentation to support resolution.
• Investigate and follow up on denials, prepare corrections, and resubmit claims.
• Initiate and manage appeals for denied claims and monitor resolutions.

Skills

Analytical thinking

Strong communication

Attention to detail

Problem solving

Team collaboration

Education

4-year college degree

Tools

EPIC

Availity

Optum portals

Medicare portals

Job description

ADEC Innovations in the Philippines seeks a detail-oriented RCM AR professional to support the recovery of outstanding medical claims. The role emphasizes analytical research, communication, and adherence to payer requirements to optimize revenue cycle performance.

You will review denied claims, investigate root causes, and collaborate with teams to ensure accurate adjudication and timely payments. The position is on-site in Alabang with US shifts.