Revenue Cycle & Authorizations Expert

Staffing for Doctors; Philippines; On-site; PHP 300,000 - 420,000; Full time

Job summary

Staffing for Doctors is seeking a detail-oriented Revenue Cycle & Authorizations Specialist to manage patient eligibility, obtain prior authorizations, and drive AR recovery. You will handle about 200 claims per week, resolve denials, verify coverage, and communicate with patients and payers to keep practice revenues steady.

Requirements include 2+ years in medical billing, strong HMO expertise, CPT/ICD-10 knowledge, and CMS-1500 claim format familiarity.

Qualifications

• 2+ years of experience in medical billing and AR management.
• Experience with insurance prior authorizations.
• Strong knowledge of HMO referrals, capitation/FFS structures, and HMO-specific appeal pathways.
• Proficient in CPT, ICD-10, HCPCS, modifiers, and CMS-1500 claim formats.

Responsibilities

• Manage end-to-end follow-ups on unpaid, underpaid, and denied claims across AR aging reports.
• Research rejection reasons, resubmit corrected claims, file appeals for two high-priority HMO plans.
• Process Medicare and PPO denials to reduce aging.
• Process, track, and reconcile approximately 200 claims per week.
• Verify insurance eligibility prior to patient appointments.
• Submit, track, and secure prior authorizations from commercial and managed care payers.
• Maintain clear communication with clinical staff regarding authorization statuses.
• Place high-volume follow-up calls to HMO representatives, medical groups, and clearinghouses.
• Explain insurance coverage rules, outstanding balances, or required authorization steps to patients.

Skills

Medical billing

Accounts receivable

Prior authorizations

HMO knowledge

Coding & billing rules

Job description

Staffing for Doctors is seeking a detail-oriented Revenue Cycle & Authorizations Specialist to manage patient eligibility, obtain prior authorizations, and drive AR recovery. You will handle about 200 claims per week, resolve denials, verify coverage, and communicate with patients and payers to keep practice revenues steady.

Requirements include 2+ years in medical billing, strong HMO expertise, CPT/ICD-10 knowledge, and CMS-1500 claim format familiarity.