Medical Claims Analyst

Risewave Consulting Inc.; Pasig; On-site; PHP 279,000 - 390,600; Full time

Job summary

A healthcare consulting firm in Pasig is looking for a Medical Claims Analyst to manage collections and account follow-up. The successful candidate will resolve outstanding claims through proactive communication and problem-solving. Responsibilities include following up with payers, maintaining productivity standards, and preparing appeal documentation. Applicants should have at least one year of experience in healthcare accounts receivable or collections, be willing to work night shifts, and have a strong background in medical billing. Full onsite work is required.

Qualifications

• Minimum of 1 year of experience in Healthcare Accounts Receivable/Collections in a BPO.
• Experience in Medical Claims/Billing and AR collections.
• Background in verifying claim status and resolving disputes.

Responsibilities

• Follow up with payers via various channels to resolve outstanding claims.
• Maintain productivity and quality standards.
• Research billing guidelines and analyze issues causing payment delays.
• Communicate issues and trends to management.
• Prepare accurate appeal documentation.

Skills

Healthcare Accounts Receivable

Medical Billing

Analytical Problem-Solving

Communication Skills

Attention to Detail

Education

High School education

Job description

The Medical Claims Analyst is responsible for collections, account follow-up, billing, and allowance posting for assigned accounts. The role ensures accurate, timely resolution of outstanding claims through proactive follow-up and analytical problem-solving.

Responsibilities

• Follow up with payers via phone, email, fax, or payer portals to ensure timely resolution of outstanding claims.
• Meet and maintain daily productivity and quality standards.
• Use workflow systems, client host systems, and other tools to collect payments and resolve accounts.
• Adhere to all client and team policies and procedures.
• Maintain knowledge of timely filing deadlines for designated payers.
• Research payer-specific billing guidelines as needed.
• Analyze and resolve issues causing payer payment delays.
• Identify trends in claim issues to proactively reduce denials.
• Communicate identified issues and trends to management.
• Initiate and process appeals when necessary.
• Identify and correct medical billing errors.
• Prepare and send accurate appeal documentation and supporting records.
• Understand underpayments, overpayments, and credit balance processes.
• Assist with special A/R projects as needed; strong analytical and communication skills required.
• Maintain cooperative and courteous communication with patients, visitors, coworkers, management, and clients.
• Protect and handle PHI in accordance with HIPAA standards.
• Work independently using assigned work queues.
• Maintain confidentiality and professionalism at all times.
• Perform other duties as assigned by management.

Qualifications

• Must be willing to work night shifts/shifting schedule in Ortigas, Pasig (Full Onsite).
• Completed at least High School education.
• Minimum of 1 year of Healthcare Accounts Receivable/Collections experience in a BPO environment (claims payment processing, status/tracking, medical billing, AR follow-ups, denials, appeals).
• Experience in Medical Claims/Billing and AR collections.
• Background in calling insurance payers to verify claim status and resolve payment disputes.