Medical Claims Specialist II - Adjudication & Coding

UST USource; Pateros; On-site; PHP 279,000 - 424,000; Full time

Job summary

UST USource is seeking a dedicated Associate to accurately process and finalize medical claims in line with established guidelines. The role emphasizes proficiency in claim processing and applicable product lines in the processing unit.

You will analyze claims, determine payment actions, ensure correct payment criteria, and address provider inquiries. A background in medical coding (ICD-10, CPT-4) and HIPAA compliance is highly valued.

Qualifications

• At least 2 years of medical claims processing experience.
• Experience in medical coding is an advantage but not required.
• Healthcare-related certification is a plus.

Responsibilities

• Process new claims or modify existing claims according to the applicable action.
• Analyze claims to determine action and approve/deny for payment.
• Determine accurate payment criteria for clearing pending claims.
• Research edits to apply physician contract pricing for entry-level claims.
• Review provider inquiries regarding claim adjudication.
• Understand and apply medical coding knowledge and claim forms.
• Handle a high volume of repetitive claims with accuracy.
• Increase productivity while maintaining quality standards.

Skills

US healthcare practices

Medical coding ICD-10

CPT-4

DRG

HCPCS

CDI

EDI

HIPAA

Excel

Windows OS

Attention to detail

Multitasking

Communication skills

Claims processing

Education

Credential or professional certification related to the field

Tools

None

Job description

UST USource is seeking a dedicated Associate to accurately process and finalize medical claims in line with established guidelines. The role emphasizes proficiency in claim processing and applicable product lines in the processing unit.

You will analyze claims, determine payment actions, ensure correct payment criteria, and address provider inquiries. A background in medical coding (ICD-10, CPT-4) and HIPAA compliance is highly valued.