Medical Claims Specialist

Risewave Consulting Inc.; Pasig; On-site; PHP 279,000 - 391,000; Full time

Benefits offered by this job

Performance Bonus

Health Insurance

HMO

Job summary

Risewave Consulting Inc. is seeking experienced Medical Claims Analysts - Accounts Receivable (AR) to join our healthcare operations team in Pasig on an on-site, full-time basis. The role focuses on handling provider billing, AR collections, and timely claims resolution, with an emphasis on CMS-1500 and UB-04 forms.

Ideal candidates have 1+ year of healthcare AR experience, strong communication skills, and knowledge of EOBs, copays, coinsurance, and deductibles. Night shift work is required.

Qualifications

• 1 year healthcare provider experience in AR collections.

Responsibilities

• Review, analyze, and process medical claims submitted on CMS-1500 and UB-04 forms.
• Perform end-to-end Accounts Receivable (AR) follow-up to ensure claims are paid promptly.
• Contact insurance companies via outbound calls to resolve claim denials, underpayments, and rejections.
• Interpret Explanation of Benefits (EOBs) to identify payment discrepancies and determine appropriate actions.
• Ensure accuracy and compliance with healthcare billing and insurance standards.
• Document all actions taken in the system, maintaining detailed and up-to-date claim records.
• Collaborate with internal teams and clients to improve claim resolution processes and reduce aging AR.

Skills

Healthcare AR

Communication skills

Outbound calls

EOB interpretation

CMS-1500 / UB-04

Attention to detail

MS Office

Education

Bachelor degree

Tools

Billing systems

Job description

On-site - Pasig 1-3 Yrs Exp Bachelor Full-time

Job Description

Employee Recognition and Rewards

Performance Bonus

Insurance Health & Wellness

Health Insurance, HMO

We are looking for experienced Medical Claims Analysts - Accounts Receivable (AR) to join our growing healthcare operations team. The role involves handling provider billing, performing AR collections, and ensuring timely and accurate claims resolution. The ideal candidate has solid experience in healthcare revenue cycle management, exceptional communication skills, and a strong understanding of medical claims processes.

Key Responsibilities

• Review, analyze, and process medical claims submitted on CMS-1500 and UB-04 forms.
• Perform end-to-end Accounts Receivable (AR) follow-up to ensure claims are paid promptly.
• Contact insurance companies via outbound calls to resolve claim denials, underpayments, and rejections.
• Interpret Explanation of Benefits (EOBs) to identify payment discrepancies and determine appropriate actions.
• Ensure accuracy and compliance with healthcare billing and insurance standards.
• Document all actions taken in the system, maintaining detailed and up-to-date claim records.
• Collaborate with internal teams and clients to improve claim resolution processes and reduce aging AR.

Qualifications

• Atleast 1 year of experience in healthcare provider (hospital or physician billing) and AR collections.
• Above-average communication skills (verbal and written).
• Willing to make outbound calls to insurance carriers.
• Knowledge of key healthcare and insurance terminologies, including copay, coinsurance, and deductibles.
• Strong understanding of EOB interpretation and familiarity with CMS-1500 and UB-04 claim forms.
• Keen attention to detail, analytical thinking, and a proactive approach to issue resolution.
• Proficient in MS Office applications and healthcare billing systems.

Work Setup: Onsite

Work Schedule Night shift

Claims Processing Medical Billing Account Receivables