Claims Denial Auditor: Improve Outcomes & Compliance

Health Business Solutions LLC; Pasig; On-site; PHP 334,800 - 446,400; Full time

Job summary

A healthcare solutions company is seeking a skilled medical claims auditor in Metro Manila, Philippines. In this role, you will review denied claims, collect necessary documentation, and collaborate with various teams to ensure accurate processing and compliance with regulations. Candidates should have a bachelor's degree, at least 3 years of experience in medical claims, and strong organizational skills. Proficiency in Microsoft Office and familiarity with claims management systems are also essential.

Qualifications

• Minimum of 3 years experience in medical claims, billing, coding, or auditing.
• Knowledge of ICD-10, CPT, and HCPCS coding.
• Ability to work with confidential patient and claims information in compliance with HIPAA.

Responsibilities

• Review denied medical claims for reasons like coding errors and eligibility.
• Collect and verify documentation needed for appeals or audits.
• Collaborate with clinical staff and billing teams to correct claim data.
• Identify trends in denials and escalate issues for process improvement.

Skills

Analytical thinking and problem-solving

Strong written and verbal communication

Time management and multitasking

Collaboration and teamwork

Process improvement mindset

Education

Bachelor's degree in healthcare administration or related field

Tools

Microsoft Office Suite

Claims management systems (Epic, Facets, Availity)

Job description

A healthcare solutions company is seeking a skilled medical claims auditor in Metro Manila, Philippines. In this role, you will review denied claims, collect necessary documentation, and collaborate with various teams to ensure accurate processing and compliance with regulations. Candidates should have a bachelor's degree, at least 3 years of experience in medical claims, and strong organizational skills. Proficiency in Microsoft Office and familiarity with claims management systems are also essential.