Medical Billing Team Lead US HMO Get A 21K Signing Bonus

ISTA Solutions; Manila; On-site; PHP 312,000 - 469,000; Full time

Benefits offered by this job

Health Insurance with free dependents

10% night differential

Attendance Bonus

Paid time off

Convertible to cash leave credits

Performance Appraisal

Job summary

ISTA Solutions in Makati is hiring a Medical Billing Specialist to support SNF and HMO billing with U.S. payers. You will verify eligibility, submit claims, post payments, and manage denials to maximize first-pass acceptance.

The role requires strong English communication, HIPAA compliance, and willingness to work onsite at Buendia, Makati in a night shift. Prior SNF billing and 2+ years U.S. billing experience preferred.

Qualifications

• Minimum 2 years of U.S. medical billing experience in a BPO/outsourcing setup.
• At least 1 year of dedicated SNF billing experience.
• Experience billing HMO, Medicare, Medicaid, Managed Care and Commercial Insurance.
• Excellent verbal and written English communications.

Responsibilities

• Process and submit SNF claims for Medicare Part A/B, Medicaid, managed care and commercial plans.
• Submit and manage HMO claims; verify referrals, authorizations and eligibility.
• Post payments and reconcile ERA/EOB; perform AR follow-up on unpaid/underpaid claims.
• Analyze denials, prepare corrected claims and appeals; track outcomes.
• Maintain HIPAA compliance; document all billing activity per CMS/payer rules.
• Stay updated on changes to reimbursement policies and payer guidelines.

Skills

US Medical Billing

SNF Billing

HMO Billing

Medicare/Medicaid Billing

AR Follow-Up

Denial Management

COB

Job description

Job Description:

ISTA Solutions, an outsourcing/offshoring company, is in search of an experienced Medical Billing Specialist to join our rapidly expanding team. As a member of our team, you will have the opportunity to work with highly skilled professionals, who prioritize employee satisfaction and work-life balance. At ISTA Solutions, we pride ourselves on creating a culture focused on long-term success and life-long learning. We're looking for a team player who is ready to contribute to our mission, just like you!

Account specific roles & responsibilities:

SNF Billing

• Process and submit claims for Skilled Nursing Facility (SNF) services.
• Bill Medicare Part A, Medicare Part B, Medicaid, Managed Care, HMO, and commercial insurance.
• Review patient census, admission, discharge, and payer information for billing accuracy.
• Verify patient eligibility, insurance coverage, authorizations, and benefit periods.
• Ensure compliance with Medicare SNF billing regulations and CMS guidelines.
• Monitor consolidated billing requirements and identify excluded services when applicable.

HMO Billing

• Submit and manage HMO claims according to payer‑specific requirements.
• Verify referrals, prior authorizations, and eligibility.
• Resolve HMO claim edits, rejections, and denials.
• Ensure timely filing and compliance with individual payer guidelines.
• Claims Processing
• Prepare, review, and submit clean claims electronically.
• Correct rejected claims and resubmit promptly.
• Monitor claim status through clearinghouses and payer portals.
• Maintain claim accuracy to maximize first-pass acceptance.
• Accounts Receivable (AR) Management
• Perform insurance follow-up on unpaid and underpaid claims.
• Research outstanding balances and payment discrepancies.
• Contact insurance companies regarding claim status and reimbursement.
• Escalate unresolved billing issues when necessary.

Payment Posting

• Post insurance payments, contractual adjustments, patient payments, and denials accurately.
• Reconcile Electronic Remittance Advice (ERA) and Explanation of Benefits (EOB).
• Identify payment variances and investigate underpayments.
• Denial Management
• Analyze denied claims to determine root causes.
• Prepare and submit corrected claims, appeals, and reconsiderations.
• Track appeal outcomes and maintain documentation.
• Compliance & Documentation
• Maintain HIPAA compliance and patient confidentiality.
• Follow CMS, Medicare, Medicaid, and payer-specific billing regulations.
• Document all billing activities thoroughly within the billing system.
• Stay updated on changes to reimbursement policies and billing requirements.

• Minimum 2 years of BPO U.S. Medical Billing experience.
• At least 1 year of dedicated SNF (Skilled Nursing Facility) billing experience.
• Experience billing HMO, Medicare, Medicaid, Managed Care, and Commercial Insurance.

Strong knowledge of:

• Medicare Part A
• Medicare Part B
• Medicaid
• Skilled Nursing Facility reimbursement
• Managed Care plans
• Coordination of Benefits (COB)
• Accounts Receivable follow-up
• Denial Management
• Appeals Process
• Electronic Claims Submission

• Excellent verbal and written English skills
• Willing to work onsite in Buendia, Makati
• Amenable working night shift

What can we offer you?

• Competitive salary and benefits
• Health Insurance with free dependents*
• 10%-night differential
• Attendance Bonus
• Paid time off
• Convertible to cash leave credits
• Performance Appraisal
• Work-life balance
• A focus on growing your career path with us
• We encourage you to follow your passions and learn new skills

Our commitment to you

• Strong culture and values-driven leadership
• We create opportunities for you to learn and grow at any stage of your career
• Continuous learning and innovation
• We foster an all inclusive environment where everyone thrives