AR Follow-Up 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

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.

DUTIES & RESPONSIBILITIES

• Review and resolve outstanding claim accounts from worklists or management direction, focusing on denied claims across various payers and regions.
• Analyze account history and conduct in-depth research, including review of patient charts and encounter documentation, to support resolution.
• 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.
• 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.
• Communicate claim issues and denial trends to leadership and contribute to continuous process improvement.
• Identifies, researches, and ensures timely processing of payments and error corrections, ensuring appropriate documentation of payments, allowances, denial, rejections, are recorded on individual accounts
• Review remittance advice and investigate underpayments or overpayments.
• Perform additional A/R tasks and support other departmental responsibilities as assigned.

JOB REQUIREMENTS

• Graduate of any 4year college degree
• Minimum of 2+ years of RCM AR experience, including experience handling both Institutional/Facility and Professional claims in a Healthcare BPO setting
• Knowledge of commercial, HMO, Medicare/Medicaid, and other payer requirements.
• Working knowledge of the use of insurance payer websites ie: Availity, Optum, Medicare, Evicore portals.
• Working knowledge of Practice Management systems, preferably EPIC.
• 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
• Amenable to work onsite in Alabang, Muntinlupa City and US shifts

PERKS OF JOINING OUR TEAM:

• Competitive salary
• Work onsite (Alabang Corporate Center)
• Free shuttle
• 15% Night Differential
• HMO DAY1 with FREE one dependent**
• Sleeping quarters with lactation room
• Employee referral bonus
• Employee engagements
• Healthy working environment
• Free webinars and internal trainings/events and more!

Office located at Alabang Corporate Center