Revenue Cycle Management Specialist

Focusinc Group Corp.; Davao City; Sur place; PHP 420 000 - 620 000; Plein temps

Avantages offerts par ce poste

Day 1 HMO

Competitive pay and incentives

Statutory government benefits

25 days paid leave

13th month pay

Onsite medical support

Employee engagement events

Employee referral program

Professional development

Résumé du poste

Focusinc Group Corp. is seeking an experienced RCM Operations Specialist in the Philippines to ensure accurate payer configurations and prompt resolution of billing issues with payers including commercial insurers, Medicare, and Medicaid.

You will collaborate with billing and coding teams to fix errors and streamline claim processing. Key responsibilities include setting up payer contracts in the billing system, managing payer portals, and addressing rejections or denials due to configuration

Qualifications

• 2+ years of healthcare experience.
• Strong time management and prioritization.
• Experience with EHR systems.
• Experience with insurance portals.
• Experience with benefit verification and authorizations.
• Detail-oriented documentation.
• Excellent written and verbal communication.
• Medical terminology experience.

Responsabilités

• Payer setup and configuration in the RCM system.
• Portal setup and access privileges for the right teams.
• Contract management reflecting terms, coding rules, and reimbursement rates.
• Billing issue resolution related to payer configuration, claims, and denials.
• Denial and rejection follow-up with denial management teams to address rejected claims.

Connaissances

Healthcare experience

Time management

EHR systems

Insurance portals

Benefit verification

Authorization submissions

Documentation detail

Communication skills

Medical terminology

Outils

Availity

CoverMyMeds

Optum

Medicare portal

Description du poste

About FGC+

#SparkSuccess at FGC+!

Since 2011, FGC+ has been committed to transforming US businesses through our all-inclusive outsourcing solutions. Through the years, we've built strong remote teams, developed customized processes, and provided exceptional customer service, helping companies soar to new heights. Our dedicated professionals excel in supporting a diverse range of industries with unmatched dedication.

Driven by our core values of Empathy, Reliability, Possibility, and Growth, we are focused on #IgnitingPossibility and helping each team member unlock their full potential. At FGC+, we offer more than just a job; we provide a nurturing environment where work-life balance, mentorship, employee engagement, and continuous learning are the pillars of your success.

Here, you are more than just an employee—you are part of a team where you can truly thrive and make a difference.

About the Job:

The RCM Operations Specialist is responsible for ensuring that all payer configurations are accurately established in the system and that any billing issues related to payer contracts, claims submission, and payment processes are promptly resolved. This role ensures that the organization is properly set up to receive reimbursements from all payers, including commercial insurers, Medicare, Medicaid, and other third‑party payers. The role also involves working closely with the billing and coding teams to correct any billing errors and ensure seamless claim processing.

What You'll Do:

1. Payer Setup and Configuration: Accurately set up and maintain payer information within the RCM system, ensuring all insurance contracts and fee schedules are correctly entered

2. Portal Setup: Ability to set up payer portals and provide privileges to the right teams

3. Contract Management: Ensure that payer contracts are correctly reflected in the billing system, including payment terms, coding rules, and reimbursement rates

4. Billing Issue Resolution: Identify and resolve any issues related to payer billing setup, provider credentialing, coding, claims rejections, underpayments, or denials due to payer configuration errors

5. Denial and Rejection Follow‑Up: Work with denial management teams to address rejected claims related to payer configuration, and correct errors that prevent claims from being processed

What You'll Bring:

• 2+ years of healthcare experience required

• Great time management and prioritization skills, ability to juggle multiple referrals at once

• Experience utilizing Electronic Health Records (EHR) systems

• Experience using insurance portals (Availity, Medicare, CoverMyMeds, Optum, etc)

• Experience doing benefit verification and submitting authorizations

• Detail oriented in documentation

• Excellent communication skills (written and verbal)

• Medical terminology experience

What we have to offer:

• A company culture based on our purpose to bring out the untapped potential, creativity, and success in people, partnerships, and brands.

• A culture built on the mission to develop high‑functioning teams by providing an environment of constructive support and inspiration where people grow personally and professionally

• A market competitive total compensation/rewards package including:

• Day 1 HMO

• Competitive pay including incentives and generous allowances

• Payment of all statutory government benefits

• 25 days of annual paid leave some days are convertible to cash

• 13th month pay

• Onsite medical support

• Employee Engagement Events

• Employee Referral Program

• Skills, training for personal and professional development