Claims Analyst - Hospice Denials Management

Health Business Solutions LLC; Manila; On-site; PHP 334,800 - 502,200; Full time

Job summary

A healthcare solutions company in Metro Manila is seeking an experienced Insurance Denials Management Specialist to analyze and resolve hospice claims denials. The successful candidate will review, appeal, and develop strategies for denials, ensuring compliance with regulations while collaborating with various teams. With at least 2 years of relevant experience and proficiency in billing and coding, the candidate must also have strong analytical and communication skills. This role offers an opportunity for professional growth in enhancing revenue cycle management.

Qualifications

• Minimum of 2 years experience in insurance denials management with a focus on hospice claims.
• In-depth understanding of hospice billing, coding (ICD-10, CPT, HCPCS), and regulatory requirements.
• Strong analytical and problem-solving skills.

Responsibilities

• Review and manage insurance claim denials related to hospice care services.
• Prepare and submit appeals to insurance payers.
• Collaborate with billing, clinical, and coding teams.

Skills

Insurance denials management

Analytical skills

Communication skills

Hospice billing knowledge

Regulatory compliance knowledge

Education

Certification in Medical Billing or Coding

Tools

Denial management software

Billing systems

MS Office applications

Job description

Job Summary

We are seeking a detail-oriented and experienced Insurance Denials Management Specialist to join our team, specializing in hospice claims. The ideal candidate will have a strong background in analyzing, appealing, and resolving insurance denials to optimize reimbursement and ensure compliance with hospice care billing regulations.

Key Responsibilities

• Review, analyze, and manage insurance claim denials specifically related to hospice care services.
• Identify root causes of claim denials and develop effective strategies for appeal and resolution.
• Prepare and submit timely and accurate appeals to insurance payers, including Medicare, Medicaid, and private insurers.
• Collaborate closely with billing, clinical, and coding teams to ensure accurate documentation and coding compliance for hospice claims.
• Monitor denial trends and report findings to management to improve revenue cycle processes.
• Maintain up-to-date knowledge of hospice billing regulations, payer policies, and industry best practices.
• Track and document all denial management activities in the appropriate systems.
• Communicate effectively with insurance companies, internal departments, and external providers to expedite claim resolutions.
• Assist in training staff on hospice-specific denials management processes and requirements.
• Contribute to process improvement initiatives to reduce denial rates and accelerate payment cycles.

Qualifications

• Minimum of 2 years experience in insurance denials management with a focus on hospice claims.
• In-depth understanding of hospice billing, coding (including ICD-10, CPT, and HCPCS), and regulatory requirements.
• Familiarity with Medicare Hospice Benefit and payer-specific policies.
• Strong analytical and problem-solving skills.
• Excellent written and verbal communication skills.
• Proficient in denial management software, billing systems, and MS Office applications.
• Ability to work independently and as part of a team in a fast-paced environment.
• Detail-oriented with strong organizational skills.

Preferred

• Certification in Medical Billing, Coding, or Revenue Cycle Management (e.g., CPC, CPB) a plus.
• Experience working with electronic health record (EHR) systems and hospice-specific billing platforms.
• Knowledge of compliance and audit requirements related to hospice care claims.