Customer Care Associate- AR Specialist

Global Healthcare Resource Philippines Inc.; Muntinlupa; On-site; PHP 420,000 - 540,000; Full time

Job summary

Global Healthcare Resource Philippines Inc. is seeking a skilled Claims Specialist to oversee the end-to-end lifecycle of medical claims from receipt to payout.

The role emphasizes accuracy in adjudication, denial management, and timely appeals within a high-volume BPO environment. The ideal candidate will have domain expertise in Behavioral Health/Mental Health claims, solid coding knowledge (ICD-10, CPT, HCPCS), and strong communication skills to collaborate with internal teams and clients

Qualifications

• Experience in end-to-end healthcare claims processing including adjudication, denial management and appeals.
• Proven exposure to Behavioral Health / Mental Health claims and billing workflows.
• Solid understanding of medical coding (ICD-10, CPT, HCPCS) and payer regulations (HIPAA, CMS).
• Excellent verbal and written communication, detail-oriented, and able to work independently or in a high-volume team.

Responsibilities

• Oversee the entire lifecycle of medical claims from receipt to final adjudication or payout.
• Manage behavioral health/mental health claims with proper coding and documentation alignment.
• Audit submissions for accuracy and compliance with payer guidelines and HIPAA/CMS regulations.
• Verify patient benefits and coverage eligibility in real time to prevent delays.

Skills

End-to-end claims processing

Denial management & appeals

Behavioral Health claims

Medical coding ICD-10 CPT HCPCS

HIPAA & CMS compliance

Strong communication

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.

• 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.