AR Follow-Up Specialist

ADEC Innovations; Muntinlupa; Vor Ort; PHP 335.000 - 580.000; Vollzeit

Benefits dieser Stelle

Free shuttle

15% Night Differential

HMO DAY1 with FREE one dependent

Sleeping quarters with lactation room

Employee referral bonus

Healthy working environment

Free webinars and trainings

Zusammenfassung

ADEC Innovations in Alabang, Muntinlupa City, Philippines, is seeking a detail-oriented RCM AR professional to support the recovery of outstanding medical claims. You will analyze denials, research documentation, and prepare corrected submissions to improve revenue cycle performance.

Applicants should have 2+ years in healthcare RCM AR, familiarity with payer portals (Availity, Optum, Medicare), and strong communication and problem-solving skills to work with cross-functional teams.

Qualifikationen

• Graduate of a 4-year college degree.
• Minimum of 2+ years of RCM AR experience in healthcare BPO.
• Knowledge of commercial, HMO, Medicare/Medicaid payer requirements.
• Experience using payer portals such as Availity, Optum, Medicare, Evicore.

Aufgaben

• Review and resolve outstanding claim accounts focusing on denied claims across payers and regions.
• Analyze account history and research patient charts to support resolution.
• Investigate and follow up on denied claims, addressing coding discrepancies or contract issues.
• Initiate and manage appeals for denied claims and resubmit corrected claims.
• Communicate denial trends to leadership and support process improvements.
• Ensure timely processing of payments and documentation of all payments and denials.
• Review remittance advice and investigate underpayments or overpayments.
• Perform additional AR tasks and support other departmental responsibilities.

Kenntnisse

RCM AR experience

Denial management

payer knowledge

Communication skills

Problem solving

Ausbildung

4-year college degree

Tools

Availity

Optum

Medicare portals

EPIC

Jobbeschreibung

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:

• Free shuttle
• 15% Night Differential
• HMO DAY1 with FREE one dependent**
• Sleeping quarters with lactation room
• Employee referral bonus
• Healthy working environment
• Free webinars and internal trainings/events and more!

Office located at Alabang Corporate Center