AR Specialist, Healthcare BPO - Alabang | Night Shift + HMO

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

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.