Revenue Cycle & Authorizations Specialist - Podiatry Clinic

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

Position Overview

We are seeking a detail-oriented, high-performing Revenue Cycle & Authorizations Specialist to manage patient eligibility, obtain prior authorizations, and drive accounts receivable (AR) recovery.

This role manages a core volume of approximately 200 claims per week, with a primary focus on navigating and resolving complex claim denials, prior authorization hurdles, and payer issues associated with two major HMO plans. The ideal candidate thrives on problem-solving, possesses strong payer navigation skills, and excels at keeping practice revenues steady and predictable.

Requirements

Primary Responsibilities

Accounts Receivable & Denials Management

• Manage end-to-end follow-ups on unpaid, underpaid, and denied claims across accounts receivable (AR) aging reports.
• Serve as the dedicated specialist for two high-priority HMO plans—actively researching rejection reasons, resubmitting corrected claims, filing appeals, and escalating administrative roadblocks.
• Process routine Medicare and PPO denials swiftly to ensure low aging across simpler payer types.
• Process, track, and reconcile approximately 200 claims per week.

Authorizations & Insurance Verification

• Perform insurance eligibility and coverage verifications prior to patient appointments.
• Submit, track, and secure prior authorizations from commercial and managed care payers to prevent coverage gaps and claim rejections.
• Maintain clear communication with clinical staff regarding authorization statuses, limitations, and approval updates.

Payer & Patient Communication

• Place high-volume follow-up calls to HMO representatives, medical groups, and clearinghouses to clear claim holds.
• Communicate politely and clearly with patients regarding insurance coverage rules, outstanding balances, or required authorization steps.

Qualifications & Key Requirements

• Experience: 2+ years of experience in medical billing, accounts receivable management, and insurance prior authorizations.
• HMO Expertise: Strong working knowledge of HMO medical group referrals, capitation/FFS structures, and HMO-specific appeal pathways.
• Coding & Billing Knowledge: Working knowledge of CPT, ICD-10, HCPCS codes, modifiers, and CMS-1500 claim formats.
• Volume Capability: Proven ability to manage a consistent workload of ~200 claims per week without sacrificing accuracy.
• Reliability: High level of punctuality and commitment to maintaining the established 38-hour weekly work schedule.