RCM Denials & Claims Resolution Specialist

KMC Solutions; Metro Manila; In loco; PHP 201.000 - 357.000; Tempo pieno

Descrizione del lavoro

KMC Solutions in the Philippines seeks a Medical Claims & Denials Specialist (RCM) to review denied or underpaid claims, coordinate appeals, and collaborate with billing and coding teams to improve denial outcomes.

The role emphasizes accurate documentation, timely follow-ups, and adherence to payer regulations, with a focus on improving denial trends and payments. Strong communication and cross-functional teamwork are essential.

Competenze

• At least 2 years of experience in Revenue Cycle Management (RCM).
• Experience in medical claims processing, denial management, medical billing, or accounts receivable (AR) is an advantage.
• Knowledge of medical claims review, denial resolution, appeals, and payer follow-up processes.
• Familiarity with denial management software, Electronic Health Record (EHR) systems, or medical billing platforms is preferred.
• Strong analytical and problem-solving skills, with attention to detail and accuracy.
• Good written and verbal communication skills.
• Ability to collaborate effectively with cross-functional teams and manage multiple claims-related tasks.

Mansioni

• Review denied or underpaid claims to identify denial reasons.
• Submit appeals with required documentation or corrections.
• Communicate with insurers to resolve outstanding claims issues.
• Ensure timely follow-ups on unresolved claims to secure payment.
• Coordinate with coding and billing to ensure correct claim submission.
• Gather supporting documentation for claims appeals and resubmissions.
• Maintain records of denied claims, appeals, and resolutions.
• Prepare basic reports on denial trends for internal review.
• Monitor denial rates, appeal success, and resolution times.
• Support workflow improvements in denial management and payer compliance.

Conoscenze

Revenue Cycle Management

Claims processing

Denial management

Medical billing

Admission AR

Analytical skills

Communication skills

Cross-functional collaboration

Attention to detail

Strumenti

EHR systems

Denial management software

Medical billing platforms

Descrizione del lavoro

KMC Solutions in the Philippines seeks a Medical Claims & Denials Specialist (RCM) to review denied or underpaid claims, coordinate appeals, and collaborate with billing and coding teams to improve denial outcomes.

The role emphasizes accurate documentation, timely follow-ups, and adherence to payer regulations, with a focus on improving denial trends and payments. Strong communication and cross-functional teamwork are essential.