Customer Care Associate- AR Specialist ( Urgent Hiring)

Global Healthcare Resource Philippines Inc.; Muntinlupa; On-site; PHP 240,000 - 420,000; Full time

Job summary

Global Healthcare Resource Philippines Inc. is hiring a Claims Specialist to oversee end-to-end medical claims processing in a busy BPO. You will adjudicate, appeal, and coordinate payouts while ensuring accuracy and adherence to HIPAA and CMS guidelines.

You will focus on behavioral health claims, verify benefits in real time, and maintain thorough documentation. Strong communication and attention to detail are essential to manage high volumes and meet tight SLAs.

Qualifications

• 1 year of hands-on experience in end-to-end healthcare claims processing within a BPO setting.
• Solid knowledge of ICD-10, CPT, HCPCS coding systems.
• Strong verbal and written communication with a keen eye for detail.

Responsibilities

• Oversee the full lifecycle of medical claims from receipt to adjudication, appeals, or payout.
• Manage complex behavioral health claims with accurate coding and documentation alignment.
• Audit submissions for accuracy and compliance with payer guidelines, HIPAA, and CMS regulations.
• Validate patient benefits and coverage in real time to prevent delays, especially for mental health services.

Skills

Verbal and written comms

Attention to detail

Independent & collaborative work

Time management

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.

• 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.

• Can start ASAP