Medical Claims Specialist: Denials & Collections

Med-Metrix; Pasig; On-site; PHP 279,000 - 446,000; Full time

Job summary

Med-Metrix is seeking a detail-oriented Medical Claims Analyst in the Philippines to manage collections, follow-ups, and billing for assigned accounts.

The role requires experience in healthcare AR, claims processing, and strong MS Office skills. You will adhere to HIPAA standards, maintain confidentiality, and work night shifts as required. You will engage with payers via calls and portals to resolve denials and post payments efficiently.

Qualifications

• Completed at least High School education.
• 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)
• Experienced on medical billing/ AR Collections
• Background in calling insurance (Payer) to verify claim status and payment dispute
• Proficiency in Microsoft Office Suite

Responsibilities

• Follow-up with payers to ensure timely resolution of all outstanding claims
• Meet and maintain daily productivity/quality standards established in departmental policies
• Use the workflow system, client host system and other tools to collect payments and resolve accounts
• Adhere to the policies and procedures established for the client/team
• Performs research regarding payer specific billing guidelines as needed
• Ability to analyze, identify trend claims issues to proactively reduce denials and resolve issues causing payer payment delays
• Communicate to management any issues and/or trends identified
• Initiate appeals when necessary
• Identify and correct medical billing errors
• Send appropriate appeals, accurate requesting information, supporting documentation, and effective communication to complete recovery process
• 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
• Use, protect and disclose patients' protected health information (PHI) only in accordance with 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

Skills

AR Collections

Medical Billing

Interpersonal skills

Problem Solving

HIPAA compliance

Education

High School Diploma

Tools

Microsoft Office

Job description

Med-Metrix is seeking a detail-oriented Medical Claims Analyst in the Philippines to manage collections, follow-ups, and billing for assigned accounts.

The role requires experience in healthcare AR, claims processing, and strong MS Office skills. You will adhere to HIPAA standards, maintain confidentiality, and work night shifts as required. You will engage with payers via calls and portals to resolve denials and post payments efficiently.