Credit Management Representative

Med-Metrix; Pasig; On-site; PHP 279,000 - 390,600; Full time

Benefits offered by this job

8-Hour Shifts, Fixed Weekends Off

Day 1 HMO with dependents

Medical Cash Allowance

Rice Allowance

Clothing Allowance

Paid Time Off

Training and Staff Development

Free Lunch Daily

Job summary

A healthcare solutions provider located in Pasig, Philippines is hiring a Credit Management Representative. The role includes managing credit balances, resolving patient account issues, and preparing refund requests. Candidates should have a high school diploma and at least one year of experience in insurance collections or credit balance management. The position offers an onsite work setup with a range of employee benefits including health coverage and allowances.

Qualifications

• 1-year experience in insurance collections or credit balance management.
• 1-3 years experience in Physician/Professional billing.
• Basic knowledge of healthcare claims processing including ICD-10, CPT, and HCPC codes.

Responsibilities

• Perform credit balance management for multiple clients.
• Review daily credit balance work list to research accounts.
• Prepare and submit refund requests with appropriate documentation.

Skills

Insurance collections

Credit balance management

Payment posting

Microsoft Office proficiency

Strong communication skills

Organizational skills

Interpersonal skills

Problem-solving skills

Education

High School diploma or equivalent

Job description

Location: Med-Metrix, Pasig, National Capital Region, Philippines

Credit Management Representative role at Med-Metrix.

Benefits

• 8-Hour Shifts, Fixed Weekends Off
• Day 1 HMO with 2 of your dependents covered for FREE
• Group Life Insurance
• Medical Cash Allowance
• Rice Allowance
• Clothing Allowance
• Holiday Gift
• Bereavement Assistance
• Free Lunch Daily
• Paid Time Off
• Training and Staff Development
• Employee Engagement Activities
• Opportunities for Internal Mobility

Job Purpose

The Credit Management Representative is responsible for all elements of Credit Balance Management which include but is not limited to triaging patient and insurance credit balance to determine root cause, correcting contractual/manual adjustments, identifying overpayments and creating refund requests including appropriate documentation to support the refund, identifying posting/payer trends and communicating to management for resolution.

Duties And Responsibilities

• Perform credit balance management for multiple clients.
• Review daily credit balance work list to research credit balance accounts.
• Research, identify root cause, and resolve patient accounts including but not limited to posting errors, insurance overpayments, patient overpayments, and/or system issues.
• Prepare and submit refund requests as appropriate, obtaining all pertinent back‑up data including EOBs, insurance company correspondence, refund letter of explanation and explanation of reimbursement from practice management system.
• Correct all misapplied contractual adjustments.
• Prepare spreadsheets for payers regarding special projects involving erroneous refunds and payer retractions.
• Review payer refund request letters and take appropriate action to resolve and respond timely.
• Maintain WQ’s assigned to ensure accounts are worked in a timely manner.
• Identify trends and expedite to supervisor.
• Adhere to unique client‑specific assigned workflows & tasks.
• Collaborate effectively with co‑source partners and other functional teams supporting the business.
• Retrieve EOBs to post payments & denials.
• Uses the MCX workflow system, client host system, payer websites and other tools available.
• Perform special projects and other duties as needed; assist with special projects by utilizing Excel spreadsheets and the ability to communicate results.
• Meet and maintain daily productivity standards established in departmental policies.
• Adhere to the policies and procedures established for the client/team.
• Always maintain confidentiality.
• Maintain a professional attitude.
• Other duties as assigned by the management team.
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with HIPAA standards.
• Understand and comply with Information Security and HIPAA policies and procedures at all times.
• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties.

Qualifications

• High School diploma or equivalent required.
• 1-year experience in insurance collections, credit balance management and/or payment posting.
• 1‑3 years experience in Physician/Professional billing.
• Working knowledge of the insurance follow‑up process with understanding of the fundamental concepts in healthcare reimbursement methodologies.
• Understanding an EOB and what the remarks or denials mean.
• Basic knowledge of healthcare claims processing including ICD‑10, CPT, and HCPC codes.
• Ability to work well individually and in a team environment.
• Proficiency with Microsoft Office.
• Strong communication skills (oral and written).
• Strong organizational skills.
• Strong interpersonal skills, ability to communicate well at all levels of the organization.
• Strong problem‑solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses.
• High level of integrity and dependability with a strong sense of urgency and results oriented.
• Excellent written and verbal communication skills required.
• Gracious and welcoming personality for customer service interaction.

Working Conditions

• Work Set‑Up: Onsite.
• Work Schedule: Predominantly day shift; must be flexible to accommodate business needs.
• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
• Work Environment: The noise level in the work environment is usually minimal.

Med‑Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non‑merit based factors, or any other characteristic protected by federal, state or local law.