RCM Specialist: Payer Setup & Denials

FGC+; Davao City; On-site; PHP 650,000 - 850,000; Full time

Benefits offered by this job

Day 1 HMO

Competitive pay

Government benefits

25 days annual leave

13th month pay

Onsite medical support

Employee Engagement Events

Employee Referral Program

Skills training

Job summary

FGC+ seeks an RCM Operations Specialist to ensure payer configurations are correctly set up in the system and to resolve billing issues across payer contracts, claims submission, and payment processes.

You will collaborate with billing and coding teams to correct errors and ensure seamless claim processing with payers including commercial insurers, Medicare, and Medicaid. This role requires healthcare experience and detail orientation.

Qualifications

• 2+ years healthcare experience required.
• Strong time management and prioritization skills.
• Experience with Electronic Health Records (EHR) systems.
• Experience using insurance portals (Availity, Medicare, CoverMyMeds, Optum).
• Experience with benefit verification and authorizations.
• Detail oriented with thorough documentation.
• Excellent written and verbal communication.
• Medical terminology experience.

Responsibilities

• Payer setup and configuration in the RCM system, ensuring contracts and fee schedules are correct.
• Set up payer portals and grant appropriate access to teams.
• Ensure payer contracts are reflected in billing with terms and reimbursement rates.
• Identify and resolve payer billing issues including denials or underpayments.
• Collaborate with denial management to address rejected claims and fix configuration errors.

Skills

Healthcare experience

Time management

Prioritization

EHR systems

Insurance portals

Benefit verification

Detail oriented

Communication skills

Medical terminology

Tools

EHR systems

Availity

Medicare

CoverMyMeds

Optum

Job description

FGC+ seeks an RCM Operations Specialist to ensure payer configurations are correctly set up in the system and to resolve billing issues across payer contracts, claims submission, and payment processes.

You will collaborate with billing and coding teams to correct errors and ensure seamless claim processing with payers including commercial insurers, Medicare, and Medicaid. This role requires healthcare experience and detail orientation.