Hospital Claims Specialist - Remote Eligible After Training

Imagenet; Makati; Remote; PHP 446,000 - 670,000; Full time

Benefits offered by this job

DAY 1 HMO Coverage

Equipment Provided

Potential WFH setup based on perf

Job summary

Imagenet, a technology-forward healthcare operations partner, seeks a Hospital Claims Specialist with extensive experience adjudicating US hospital claims. The role requires accurate analysis of inpatient, outpatient, and complex cases, ensuring compliance with HIPAA and policy guidelines.

Training will be onsite in Makati for 6 months, with potential WFH eligibility later based on performance. The ideal candidate brings deep knowledge of UB-04, 837I, DRG/APR-DRG methods, and COB.

Qualifications

• 5+ years of hands-on experience adjudicating US hospital or facility claims in a payer, TPA, or managed care setting.
• Strong knowledge of institutional billing, including UB-04 and 837I claim formats.
• Experience handling inpatient, outpatient, ER, Home Health and SNF claims, including complex cases.
• Understanding of DRG/APR-DRG reimbursement, Medicare/Medi-Cal processing, and COB concepts.
• Ability to interpret provider contracts, payer policies, and benefit summaries.

Responsibilities

• Review and adjudicate hospital and facility claims (inpatient, outpatient, ER, ancillary, Home Health, SNF) according to plans and procedures.
• Validate accuracy: eligibility, cost share, provider, dates of service, authorizations, docs.
• Make determinations to pay, deny, adjust, pend, or contest with rationale.
• Apply member cost share and COB; identify over/underpayments.
• Investigate high-dollar or complex claims using data, records, and history.
• Maintain audit-ready claim notes and support audits with documentation.

Skills

Analytical skills

Attention to detail

English communication

Independence in reviewing claims

Tools

UB-04 forms

837I claim formats

CPT/HCPCS/ICD-10-CM/PCS knowledge

Job description

Imagenet, a technology-forward healthcare operations partner, seeks a Hospital Claims Specialist with extensive experience adjudicating US hospital claims. The role requires accurate analysis of inpatient, outpatient, and complex cases, ensuring compliance with HIPAA and policy guidelines.

Training will be onsite in Makati for 6 months, with potential WFH eligibility later based on performance. The ideal candidate brings deep knowledge of UB-04, 837I, DRG/APR-DRG methods, and COB.