Medical Claims Analyst - AR Collections & Billing (with 25k SOB)

MED-METRIX INTERNATIONAL PH-I, INC.; Pasig; On-site; PHP 279,000 - 391,000; Full time

Benefits offered by this job

8-Hour Shifts

Fixed Weekends Off

Day 1 HMO with 2 dependents covered

Group Life Insurance

Medical Cash Allowance

Rice Allowance

Clothing Allowance

Holiday Gift

Bereavement Assistance

Free Lunch Daily

Paid Time Off

Training and Staff Development

Employee Engagement Activities

Opportunities for Internal Mobility

Job summary

Med-Metrix International PH-I, INC. is hiring a Medical Claims Analyst to manage collections, account follow-up, billing and posting for assigned accounts.

You will work onsite in the Philippines and engage with payers to resolve claims efficiently. The ideal candidate has at least 1 year in Healthcare AR/Collections, experience with US healthcare, and strong communication skills to handle denials, appeals and PHI with HIPAA compliance.

Qualifications

• Minimum 1 year of Healthcare AR/Collections in a BPO setting and US healthcare experience.
• Mixture of back-office support and outbound call tasks (approximately 70% back-office, 30% outbound).
• Experience with medical billing and AR collections.
• Experience processing workers' compensation benefits.
• Experience calling insurance to verify claim status and payment disputes.
• Strong communication and problem-solving skills with attention to detail.
• High integrity and ability to handle PHI with care.

Responsibilities

• Follow-up with payers to ensure timely resolution of outstanding claims via phone, email, fax or websites.
• Meet daily productivity and quality standards as defined by policies.
• Use workflow and client host systems to collect payments and resolve accounts.
• Adhere to client and team policies and procedures.
• Understand timely filing deadlines for designated payers.
• Research payer-specific billing guidelines as needed.
• Identify and resolve issues causing payer payment delays and trend denial causes.

Skills

Healthcare AR/Collections

US healthcare experience

Outbound calling

Medical billing

Denials & Appeals

Communication skills

HIPAA compliance

Confidentiality

Tools

Workflow system

Client host system

Job description

WE ARE HIRING MEDICAL CLAIMS ANALYST!!!

Join our dynamic team and make a meaningful impact in the healthcare industry. As a Medical Claims Analyst, you'll play a pivotal role in ensuring accurate claims processing while advancing your career in a supportive and innovative environment. Enjoy competitive benefits upon hire, ongoing professional development, and the satisfaction of helping others every day. Take the next step in your career with Med-Metrix!

Experience these exceptional benefits when you join Med-Metrix!

• 8-Hour Shifts, Fixed Weekends Off

• Day 1 HMO with 2 of your dependents covered for FREE

• Group Life Insurance

• Medical Cash Allowance

• Rice Allowance

• Clothing Allowance

• Holiday Gift

• Bereavement Assistance

• Free Lunch Daily

• Paid Time Off

• Training and Staff Development

• Employee Engagement Activities

• Opportunities for Internal Mobility

Job Purpose

The Medical Claims Analyst is responsible for collections, account follow up, billing and allowance posting for the accounts assigned to them.

Duties and Responsibilities

• Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or websites

• Meets and maintains daily productivity/quality standards established in departmental policies

• Uses the workflow system, client host system and other tools available to them to collect payments and resolve accounts

• Adheres to the policies and procedures established for the client/team

• Knowledge of timely filing deadlines for each designated payer

• Performs research regarding payer specific billing guidelines as needed

• Ability to analyze, identify and resolve issues causing payer payment delays

• Ability to analyze, identify and trend claims issues to proactively reduce denials

• Communicates to management any issues and/or trends identified

• Initiate appeals when necessary

• Ability to identify and correct medical billing errors

• Send appropriate appeals, accurate requesting information, supporting documentation, and effective communication to complete recovery process

• Understanding of under or over payments and credit balance processes

• Assist with special A/R projects as needed. Analytical skills and the ability to communicate results are required

• Act cooperatively and courteously with patients, visitors, co-workers, management and clients

• Work independently from assigned work queues

• Maintain confidentiality at all times

• Maintain a professional attitude

• Other duties as assigned by the management team

• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards

• Understand and comply with Information Security and HIPAA policies and procedures at all times

• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Qualifications

• Minimum 1 year of Healthcare Account Receivable/Collections in a BPO setting or environment (claims payments processing, claims status and tracking, Medical Billing, AR Follow ups, Denials and Appeals-outbound healthcare providers) and at least 1 year US healthcare - Medical/Healthcare Insurance experience.

• Amenable to handling a mixture of 70% back-office support and 30% outbound call support

• Experienced on medical billing/ AR Collections

• Must have an experience processing workers compensation benefits.

• Background in calling insurance (Payer) to verify claim status and payment dispute

• Strong interpersonal skills, ability to communicate well at all levels of the organization

• Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses

• High level of integrity and dependability with a strong sense of urgency and results oriented

• Excellent written and verbal communication skills required

• Gracious and welcoming personality for customer service interaction

Working Conditions

• Must be amenable to work night shifts

• Must be willing to work onsite

• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.

• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.

• Work Environment: The noise level in the work environment is usually minimal.