Claims Associate II - BPM

UST USource; Pateros; On-site; PHP 279,000 - 424,000; Full time

Job summary

UST USource is seeking a dedicated Associate to accurately process and finalize medical claims in line with established guidelines. The role emphasizes proficiency in claim processing and applicable product lines in the processing unit.

You will analyze claims, determine payment actions, ensure correct payment criteria, and address provider inquiries. A background in medical coding (ICD-10, CPT-4) and HIPAA compliance is highly valued.

Qualifications

• At least 2 years of medical claims processing experience.
• Experience in medical coding is an advantage but not required.
• Healthcare-related certification is a plus.

Responsibilities

• Process new claims or modify existing claims according to the applicable action.
• Analyze claims to determine action and approve/deny for payment.
• Determine accurate payment criteria for clearing pending claims.
• Research edits to apply physician contract pricing for entry-level claims.
• Review provider inquiries regarding claim adjudication.
• Understand and apply medical coding knowledge and claim forms.
• Handle a high volume of repetitive claims with accuracy.
• Increase productivity while maintaining quality standards.

Skills

US healthcare practices

Medical coding ICD-10

CPT-4

DRG

HCPCS

CDI

EDI

HIPAA

Excel

Windows OS

Attention to detail

Multitasking

Communication skills

Claims processing

Education

Credential or professional certification related to the field

Tools

None

Job description

Responsible for the accurate processing and completion of medical claims based on defined claims guidelines and policies. The Associate can demonstrate proficiency in product lines applicable to the processing unit.

Responsibilities

• Process new claims or modify existing claims according to the appropriate and applicable action.
• Analyze claims to determine the appropriate action and approve or deny claims for payment.
• Determine accurate payment criteria for clearing pending claims based on defined policies and procedures.
• Research claim edits to determine appropriate benefit application utilizing established criteria and apply physician contract pricing as needed for entry-level claims.
• Review and address provider inquiries regarding claim adjudication.
• Understand and apply knowledge of medical coding (if applicable) and various medical claim forms to the claims process.
• Demonstrate the ability to work on a high volume of repetitive claims.
• Demonstrate increasing productivity to meet minimum requirements while maintaining quality standards.

Qualifications

Education

• Credential or professional certification related to the current field of work is an advantage.

Work Experience

• At least 2 years of medical claims processing experience.
• Experience in medical coding, including diagnosis coding and terminology, an advantage but not required

Skillset

• Proficient knowledge of U.S. healthcare practices, medical coding (ICD-10, CPT-4, DRG, HCPCS), Clinical Documentation Improvement (CDI), medical terminologies, EDI, and HIPAA protocols.
• Ability to multitask and follow documented claims processes with minimal supervision.
• Excellent verbal and written business communication skills.
• Strong proficiency in Windows OS and Microsoft Office applications, particularly Excel.
• Strong attention to detail and the ability to make appropriate decisions based on the information presented.