RCM Specialist – Billing and Collections (with Call Handling)

Outsource Philippines; San Pedro; On-site; PHP 420,000 - 660,000; Full time

Job summary

Outsource Philippines in Laguna, Philippines is seeking an RCM Specialist – Billing and Collections with Call Handling to manage end-to-end US healthcare billing and collections, including claim processing, posting, follow-up, and professional call handling with payers and patients.

The role emphasizes accuracy, HIPAA/compliance, communication skills, and ability to work US business hours onsite in San Pedro.

Job description

RCM Specialist – Billing and Collections (with Call Handling)

Manage end-to-end US healthcare billing and collections through accurate claim processing, payment posting, A/R follow-up, and direct call handling with payers and patients, while maintaining strict compliance and performance standards.

JOB OVERVIEW:

We are looking for detail-oriented and service-focused RCM Specialists to support a US-based healthcare provider. The role combines healthcare revenue cycle management (RCM), medical billing and collections, payment posting, reconciliation, and call handling.

The successful candidates will help ensure that payments and adjustments are accurately recorded, outstanding claims and balances are properly followed up, billing inquiries are handled professionally, and account records are complete and up to date.

This position is suited to candidates with hands‑on experience in medical billing, healthcare accounts receivable, payment posting, collections, or related healthcare revenue cycle operations who can work accurately while communicating effectively with callers and internal stakeholders.

QUALIFICATIONS:

Required

• Relevant degree in Healthcare Administration, Business Administration, Accounting, Finance, or a related field, or an equivalent combination of relevant education and practical experience
• Good written and spoken English, including the ability to communicate professionally during billing-related calls
• Strong attention to detail, numerical accuracy, analytical thinking, and problem-solving skills
• Good documentation, organization, follow through, and time-management skills
• Ability to investigate discrepancies, follow established procedures, and recognize when escalation is necessary
• Willingness and ability to work within US business hours schedule (permanent) and onsite at our San Pedro, Laguna facility

Preferred

• At least one year of experience in medical billing, healthcare revenue cycle management, payment posting, medical accounts receivable, collections, or a related healthcare operations role
• Hands-on experience reviewing Electronic Remittance Advice (ERA) and Explanation of Benefits (EOB) documents and posting payments or adjustments
• Experience with claims follow up, denials, recoupments, reconciliation, or healthcare collections
• Experience handling billing-related calls and communicating with insurance payers, patients, or responsible parties
• Familiarity with CentralReach or other healthcare practice management and billing systems
• Knowledge of ABA (Applied Behavior Analysis) healthcare billing, medical terminology, CPT/HCPCS codes, ICD-10, or electronic remittance transactions such as 835 files
• Proficiency in Microsoft Excel and other relevant office or reporting tools

SKILLS AND PERSONAL ATTRIBUTES:

• Accuracy and accountability in handling financial and patient-related records
• Professional, patient, and courteous communication
• Confidence in asking relevant questions and clarifying incomplete information
• Good judgment when handling discrepancies, sensitive inquiries, and exceptions
• Ability to manage repetitive, detail-intensive tasks while maintaining quality
• Adaptability and willingness to learn the client’s systems, workflows, and requirements
• A collaborative approach to working with supervisors, colleagues, and client stakeholders

JOB DESCRIPTIONS:

• Prepare, review, and submit electronic and paper claims to commercial, government, and managed care payers in accordance with instructions and guidance provided by Client.
• Ensure claims are complete, accurate, and compliant with payer-specific billing requirements.
• Monitor claim status and resolve claim rejections, denials, and edits.
• Verify coding, modifiers, authorizations, and supporting documentation prior to claim submission.

Accounts Receivable Follow Up

• Perform timely follow up on outstanding insurance and client balances in accordance with guidelines set forth by Client.
• Investigate and resolve unpaid, underpaid, or denied claims
• Communicate with insurance carriers to obtain claim status and secure payment resolution.
• Escalate complex reimbursement issues as needed.

Payment Posting and Reconciliation

• Accurately post insurance and client payments, adjustments, and contractual allowances.
• Reconcile payments against claims submitted and expected reimbursement.
• Research and correct posting discrepancies.
• Assist with daily, weekly, and monthly reconciliation activities.

Client Billing and Customer Service

• Respond to client billing inquiries in a professional and courteous manner.
• Explain insurance benefits, client financial responsibility, and payment options.
• Process refunds, payment plans, and account adjustments according to company policy.
• Maintain detailed documentation Of client and payer communications.

Compliance and Reporting

• Maintain compliance with HIPAA, CMS regulations, and payer guidelines.
• Ensure proper documentation of billing activities within practice management and EHR systems.
• Generate and review billing, denial, and accounts receivable reports
• Identify trends impacting reimbursement and recommend process improvements.