Claims Follow-up Specialist | Permanent WFH

BizForce; Metro Manila; Remote; PHP 420,000 - 540,000; Full time

Benefits offered by this job

Permanent Work From Home

Leave Credits

Monetary Allowance

Annual Bonus

Weekly Paychecks

Fixed Weekends Off

Thriving Company Culture with Complete

Autonomy

Exclusive Specialized Training

Competitive Salary

Job summary

BizForce is seeking a detail-oriented Claims Follow-up Specialist to join our healthcare revenue cycle management team in a remote capacity from the Philippines. The ideal candidate will ensure accurate claims submission, timely reimbursement, and efficient resolution of denied claims using Epic’s Professional Billing suite.

The role requires hands-on experience with medical billing, denial management, and payer communications, with a patient-centered approach and adherence to HIPAA guidelines.

Qualifications

• High school diploma or equivalent.
• Certifications in revenue cycle or medical billing are a plus (CRCS, CPB, CPC).
• Hands-on experience with Epic systems, especially Professional Billing, is required or strongly preferred.

Responsibilities

• Review, submit, and follow up on medical insurance claims to ensure accurate and timely reimbursement.
• Apply payer guidelines to minimize rejections and ensure clean claims submission.
• Monitor outstanding claims and take action to secure reimbursement.
• Review EOBs, ERAs, and payment discrepancies; support claim corrections and appeals.
• Coordinate with insurance representatives to resolve complex issues and prevent recurring denials.
• Collaborate with Patient Services to address escalated billing inquiries and explain statements clearly.

Education

High school diploma or equivalent

Certified Revenue Cycle Specialist (CRCS)

Certified Professional Biller (CPB)

Certified Professional Coder (CPC)

Tools

Epic

Epic Prelude

Epic Cadence

Epic Ambulatory

Professional Billing module

Job description

We are seeking a detail-oriented and highly motivated Claims Follow-up Specialist to join our healthcare revenue cycle management team. In this role, you will be responsible for ensuring accurate claims submission, timely reimbursement, and efficient resolution of denied or outstanding insurance claims.
The ideal candidate has a strong background in medical billing, insurance claims follow-up, and denial management, with hands-on experience using Epic, particularly its Professional Billing module. This position requires excellent problem-solving skills, strong payer communication abilities, and a patient-centered approach to resolving billing concerns.

Key Responsibilities

Claims Submission & Follow-up

• Review, submit, and follow up on medical insurance claims to ensure accurate and timely reimbursement.
• Apply commercial and government payer guidelines to ensure clean claims submission and minimize rejections.
• Monitor outstanding claims, identify payment delays, and take appropriate action to secure reimbursement.
• Review Explanation of Benefits (EOBs), Electronic Remittance Advice (ERAs), and payment discrepancies.
• Process medical record requests from insurance carriers to support claims adjudication.

Denial Management & Resolution

• Investigate and resolve denied, rejected, underpaid, and unpaid claims.
• Identify denial root causes and implement appropriate corrective actions.
• Review clinical documentation, billing records, and payer requirements to support reconsiderations and appeals.
• Prepare and submit corrected claims, appeals, and supporting documentation within payer deadlines.
• Coordinate with insurance representatives to resolve complex claim issues and prevent recurring denials.

Patient Billing & Insurance Support

• Collaborate with Patient Services Representatives to address escalated patient billing and insurance inquiries.
• Explain billing statements, insurance coverage, claim statuses, and payment responsibilities clearly and professionally.
• Handle inbound calls from patients and insurance representatives as needed.
• Maintain patient confidentiality and ensure compliance with HIPAA regulations.

Epic Systems & Compliance

• Utilize Epic applications, including Prelude, Cadence, Ambulatory, and Professional Billing, to review and manage patient accounts and claims.
• Maintain accurate documentation of claim follow-up activities, payer communications, and resolutions.
• Stay informed about changes in insurance policies, reimbursement guidelines, and healthcare billing regulations.
• Ensure all billing and claims management activities comply with organizational policies and industry standards.

Team Collaboration & Continuous Improvement

• Work closely with billing, clinical, and Patient Services teams to resolve reimbursement issues.
• Participate in team meetings, training sessions, and process improvement initiatives.
• Identify recurring claim issues and recommend solutions to improve collections and reduce denials.
• Perform additional revenue cycle management duties as assigned.

Qualifications

• High school diploma or equivalent.
• Proven experience in medical claims follow-up, insurance billing, accounts receivable, or denial management.
• Hands-on experience with Epic, preferably Professional Billing, Prelude, Cadence, or Ambulatory.
• Strong understanding of commercial insurance, Medicare, Medicaid, and payer reimbursement guidelines.
• Experience reviewing EOBs, ERAs, claim denials, and outstanding insurance balances.
• Knowledge of medical billing processes, claim corrections, reconsiderations, and appeals.
• Understanding of HIPAA regulations and patient confidentiality requirements.
• Professional certification such as Certified Revenue Cycle Specialist (CRCS), Certified Professional Biller (CPB), or Certified Professional Coder (CPC).
• Previous experience supporting a multi-specialty healthcare practice, physician group, or healthcare revenue cycle organization.
• Experience handling professional billing claims and complex insurance denials.
• Amenable to work during US hours
• Must be willing to undergo a background check as part of the hiring process.

Perks

• Permanent Work From Home
• Leave Credits
• Monetary Allowance
• Annual Bonus
• Weekly Paychecks
• Fixed Weekends Off
• Thriving Company Culture with Complete Autonomy
• Exclusive Specialized Training Programs
• Unlock Your Potential with a Highly Competitive Salary

Who are we?

BizForce is one of the fastest-growing global outsourcing companies in the world, founded in the US in Tucson, Arizona and is now operational in PH!
Our Commitment to delivering high-quality results for our clients and the only way to do that is ensuring a rewarding, respectful and productive experience for our employees. We hold the same values for both our customers and our employees.