(RCM) Revenue Integrity Specialist (Start-up Shared Services) - NES1

John Clements Consultants, Inc.; Quezon City; On-site; PHP 450,000 - 650,000; Full time

Job summary

John Clements Consultants, Inc. seeks a Revenue Integrity Specialist to support reimbursement accuracy and revenue recovery initiatives.

You will identify payer underpayments and overpayments, analyze reimbursement variances, and pursue corrections through reconsiderations and disputes. Responsibilities include reviewing contracts, fee schedules, and reimbursement methodologies, investigating variances, and collaborating with Revenue Cycle teams.

Qualifications

• Bachelor’s degree preferred.
• 3+ years in Revenue Cycle/AR/Denials or related.
• Experience reviewing ERA/EOB and payer remittance activity.
• Knowledge of payer contracts, fee schedules, and reimbursement methodologies.
• Experience with appeals, disputes, underpayment recovery, or reimbursement research.
• Familiarity with EMR/Practice Management systems.
• Strong analytical, problem-solving, and communication skills.
• Willing to work ON-SITE and in a NIGHT-SHIFT schedule.
• Must be open to work in Bridgetowne, Quezon City.

Responsibilities

• Analyze payer reimbursements and identify payment discrepancies.
• Review payer contracts, fee schedules, and reimbursement methodologies.
• Investigate underpayments, overpayments, and contractual variances.
• Submit and track payer reconsiderations, disputes, and recovery efforts.
• Research ERA, EOB, claim adjudication, and payment history.
• Identify reimbursement trends and support process improvement initiatives.
• Collaborate with Coding, Denials, Managed Care, and other Revenue Cycle teams.

Skills

Analytical skills

Problem solving

Communication skills

Education

Bachelor's degree

Tools

EMR/Practice Management systems

Job description

About the Role

We're seeking a Revenue Integrity Specialist to support reimbursement accuracy and revenue recovery initiatives. This role is responsible for identifying payer underpayments and overpayments, analyzing reimbursement variances, maintaining payer contract information, and pursuing payment corrections through reconsiderations and disputes.

Key Responsibilities

• Analyze payer reimbursements and identify payment discrepancies.

• Review payer contracts, fee schedules, and reimbursement methodologies.

• Investigate underpayments, overpayments, and contractual variances.

• Submit and track payer reconsiderations, disputes, and recovery efforts.

• Research ERA, EOB, claim adjudication, and payment history.

• Identify reimbursement trends and support process improvement initiatives.

• Collaborate with Coding, Denials, Managed Care, and other Revenue Cycle teams.

Qualifications

• Bachelor's degree preferred.

• 3+ years of experience in Revenue Cycle, AR, Denials, Medical Billing, Reimbursement Analysis, or Contract Management.

• Experience reviewing ERA, EOB, and payer remittance activity.

• Knowledge of payer contracts, fee schedules, and reimbursement methodologies.

• Experience with appeals, disputes, underpayment recovery, or reimbursement research.

• Familiarity with EMR/Practice Management systems.

• Strong analytical, problem-solving, and communication skills.

• Willing to work ON-SITE and in a NIGHT-SHIFT schedule

• Must be open to work in Bridgetowne, Quezon City