CSR- Accounts Receivable

Global Healthcare Resource; Muntinlupa; Sur place; PHP 350 000 - 520 000; Plein temps

Résumé du poste

Global Healthcare Resource is seeking a Claims Specialist to oversee the full claims lifecycle, from receipt to payout, with a focus on behavioral health claims and rapid verification of benefits. The role requires meticulous attention to coding standards (ICD-10, CPT, HCPCS) and strict adherence to HIPAA and CMS guidelines.

The ideal candidate will have at least 1 year of hands-on experience in a BPO setting, strong communication, and the ability to thrive in a high-volume environment while

Qualifications

• Minimum of 1 year of hands-on experience in end-to-end healthcare claims processing, denial management, appeals, or claims analysis in a BPO setting.
• Solid understanding of ICD-10, CPT, HCPCS, claim types, HIPAA, CMS regulations.
• Strong communication skills and attention to detail; ability to work independently or in a high-volume team.

Responsabilités

• Oversee the entire lifecycle of medical claims, from initial receipt and adjudication through to final resolution, appeal, or payout.
• Manage behavioral health specialization, ensuring alignment with coding and documentation standards for mental health services.
• Audit submissions for accuracy and policy alignment with payer guidelines, HIPAA, and CMS regulations.
• Real-Time Verification: Validate patient benefits and coverage eligibility swiftly to prevent processing delays, especially for mental health benefits.

Connaissances

communication

attention to detail

adaptability

Description du poste

• Comprehensive Claims Management: Oversee the entire lifecycle of medical claims, from initial receipt and adjudication through to final resolution, appeal, or payout.
• Behavioral Health Specialization: Manage complex claims specific to behavioral and mental health services, ensuring accurate alignment with specialized coding and documentation standards.
• Quality Assurance & Compliance: Audit submissions for accuracy and policy alignment, ensuring full compliance with payer guidelines, HIPAA, and CMS regulations.
• Real-Time Verification: Validate patient benefits and coverage eligibility swiftly to prevent processing delays, particularly regarding mental health benefits.

Required Qualifications

• Experience: Minimum of 1 year of hands-on experience in end-to-end healthcare claims processing, denial management, appeals, or claims analysis specifically within a BPO setting.
• Technical Knowledge: Solid understanding of medical coding systems (ICD-10, CPT, HCPCS), diverse claim types, and industry-standard regulations (HIPAA, CMS, etc.).
• Core Skills: Strong verbal and written communication abilities, a sharp eye for detail, and the flexibility to thrive both independently and collaboratively in a high-volume environment.