CSR- Accounts Receivable

Global Healthcare Resource Philippines Inc.; Muntinlupa; On-site; PHP 360,000 - 480,000; Full time

Job summary

Global Healthcare Resource Philippines Inc. seeks an experienced claims specialist to manage end-to-end medical claims, with a focus on behavioral health, within a high-volume BPO environment.

You will verify benefits in real time, ensure HIPAA/CMS compliance, and use AMD AdvancedMD for coding and billing to drive accurate, timely claim resolutions.

Qualifications

• 1 year hands-on experience in end-to-end healthcare claims processing in a BPO setting.
• Experience handling Behavioral Health / Mental Health claims and billing workflows.
• Proficient with AMD AdvancedMD software for claims management.
• Solid knowledge of ICD-10, CPT, and HCPCS coding systems.
• Strong verbal and written communication with attention to detail.
• Ability to work independently and collaboratively in a high-volume environment.

Responsibilities

• Oversee lifecycle of medical claims from intake to final resolution.
• Manage behavioral health claim processing and documentation.
• Audit submissions for accuracy and payer compliance.
• Verify patient benefits in real time to prevent delays.

Skills

Claims processing

Denial management

Behavioral health

ICD-10 coding

CPT coding

HCPCS coding

HIPAA compliance

Communication skills

Detail orientation

Team collaboration

Tools

AMD AdvancedMD

Job description

Key Responsibilities

• 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.

• Domain Expertise: Proven experience handling Behavioral Health / Mental Health claims and billing workflows.

• System Proficiency: Practical experience utilizing AMD (AdvancedMD) software for claims management, scheduling, or billing functions is highly preferred.

• 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.