AR Specialist | BPO Healthcare | Alabang

ADEC INNOVATIONS HEALTHCARE, INC; Muntinlupa; On-site; PHP 391,000 - 725,000; Full time

Benefits offered by this job

Competitive Salary

WORK ONSITE (Alabang City)

HMO on Day1 with FREE ONE DEPENDENT***

US Shifts with 15% Night Differential

Free Shuttle and Free Parking

Employee referral bonus

Employee engagements

Healthy working environment

Free webinars and internal trainings

Job summary

ADEC INNOVATIONS HEALTHCARE, INC is seeking a detail-oriented professional to support the financial integrity of the organization by recovering outstanding medical claims. The role requires strong analytical and communication skills, with deep knowledge of insurance claims processes to optimize revenue cycle performance.

The position focuses on denial management, appeals, and collaboration with leadership to improve payer performance.

Qualifications

• Graduate of any 4-year college degree.
• Minimum of 2+ years of RCM AR experience, including institutional/facility and professional claims in a Healthcare BPO setting.
• Knowledge of commercial, HMO, Medicare/Medicaid, and other payer requirements.
• Working knowledge of insurance payer websites (Availity, Optum, Medicare, Evicore portals).
• Working knowledge of Practice Management systems, preferably EPIC.
• Effective communication abilities with team members outside clients and patients.
• Proven problem-solving skills; ability to research and resolve complex insurance denials.
• Proficient knowledge of medical terminology.
• Denial management experience is a plus.

Responsibilities

• Review and resolve outstanding claim accounts from worklists or management direction.
• Analyze account history and conduct in-depth research to support resolution.
• Investigate and follow up on denied claims and submit corrected claims.
• Initiate and manage appeals for denied claims and maintain follow-up activities.
• Communicate claim issues and denial trends to leadership for process improvement.
• Identify, research, and ensure timely processing of payments and adjustments.
• Review remittance advice and investigate underpayments or overpayments.
• Perform additional A/R tasks and support other departmental responsibilities.
• Report security incidents or weaknesses.
• Performs other tasks as assigned.

Skills

RCM AR experience

Insurance claims knowledge

Communication skills

Problem solving

Education

4-year college degree

Tools

Availity

Optum

Medicare/Evicore portals

Job description

JOB 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.

JOB 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.
• Reports security incidents and/or any identified security weaknesses.
• Performs other tasks that may be assigned from time to time.

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

PERKS OF JOINING US

• Competitive Salary
• WORK ONSITE (Alabang City)
• HMO on Day1 with FREE ONE DEPENDENT***
• US Shifts with 15% Night Differential
• Free Shuttle and Free Parking
• Employee referral bonus
• Employee engagements
• Healthy working environment
• Free webinars and internal trainings/events and more!

Office Location: Alabang Corporate Center