RCM Operations Specialist: Payer Setup & Denials

Focusinc Group Corp.; Davao City; On-site; PHP 420,000 - 620,000; Full time

Benefits offered by this job

Day 1 HMO

Competitive pay and incentives

Statutory government benefits

25 days paid leave

13th month pay

Onsite medical support

Employee engagement events

Employee referral program

Professional development

Job summary

Focusinc Group Corp. is seeking an experienced RCM Operations Specialist in the Philippines to ensure accurate payer configurations and prompt resolution of billing issues with payers including commercial insurers, Medicare, and Medicaid.

You will collaborate with billing and coding teams to fix errors and streamline claim processing. Key responsibilities include setting up payer contracts in the billing system, managing payer portals, and addressing rejections or denials due to configuration

Qualifications

• 2+ years of healthcare experience.
• Strong time management and prioritization.
• Experience with EHR systems.
• Experience with insurance portals.
• Experience with benefit verification and authorizations.
• Detail-oriented documentation.
• Excellent written and verbal communication.
• Medical terminology experience.

Responsibilities

• Payer setup and configuration in the RCM system.
• Portal setup and access privileges for the right teams.
• Contract management reflecting terms, coding rules, and reimbursement rates.
• Billing issue resolution related to payer configuration, claims, and denials.
• Denial and rejection follow-up with denial management teams to address rejected claims.

Skills

Healthcare experience

Time management

EHR systems

Insurance portals

Benefit verification

Authorization submissions

Documentation detail

Communication skills

Medical terminology

Tools

Availity

CoverMyMeds

Optum

Medicare portal

Job description

Focusinc Group Corp. is seeking an experienced RCM Operations Specialist in the Philippines to ensure accurate payer configurations and prompt resolution of billing issues with payers including commercial insurers, Medicare, and Medicaid.

You will collaborate with billing and coding teams to fix errors and streamline claim processing. Key responsibilities include setting up payer contracts in the billing system, managing payer portals, and addressing rejections or denials due to configuration