Eastwood Libis, QC, PH

Medical Billing Specialist - AR and Credentialing

Position Summary:

The Medical Billing Specialist - AR and Credentialing will play a vital role in our financial team with the primary responsibility of handling all aspects of claims management, from investigation to resolution. This involves reviewing and analyzing the status of claims, navigating various online portals, and regularly communicating with payers. The position also requires a proactive approach towards the investigation and analysis of claim denials, finding effective solutions to ensure their payment, and consistently following up on any outstanding claims. The Accounts Receivable Specialist will report directly to the Accounts Receivable Supervisor/Manager and contribute to the effective and efficient operation of our financial management system.

Job Details:

  • Work from home
  • Monday to Friday | 9 PM to 6 AM
  • *Following Philippine Holidays

Responsibilities:

  • Navigate Different Online Portals: Regularly access various online systems to check the status of claims, ensuring they are processed correctly and in a timely manner.
  • Communicate with Payers: Contact payer hotlines for inquiries, clarifications, and the status of claims. Display professionalism and efficiency in all interactions to maintain positive relationships.
  • Investigate Claim Denials: Proactively investigate the reasons behind claim denials, analyze the information gathered, and develop effective solutions to ensure claim payments.
  • Manage Claim Adjustments: Resubmit claims, request reprocessing, send corrected claims, and/or create appeals as needed, based on analysis and investigation results.
  • Follow Up on Outstanding Claims: Diligently and promptly follow up on any open and unpaid claim until the Accounts Receivable list is cleared up, preventing untimely resubmission or appeal.
  • Report Regularly: Provide daily reports to the Accounts Receivable Supervisor/Manager about completed tasks and any pending issues, ensuring clear and concise communication about any updates or issues that require attention.
  • Maintain the Accounts Receivable System: Regularly update the Accounts Receivable system with clear, comprehensive notes to track progress and facilitate efficient claim management.
  • Credentialing: Complete and process provider applications with meticulous attention to detail. Maintain the accuracy and completeness of provider data within our database. Effectively communicate with the team throughout the credentialing process, promptly addressing inquiries and concerns. Proactively follow up on application statuses and any missing information to expedite the credentialing process.

Qualifications:

  • At least 3 years’ experience in an accounts receivable role, with a focus on healthcare claims management.
  • Excellent ability to navigate and use various online systems and portals.
  • Strong communication skills, both verbal and written, for effective liaison with payers and internal stakeholders.
  • Proven analytical and problem-solving skills, with the ability to analyze claim denials and devise effective resolutions.
  • Attention to detail and high levels of accuracy in all tasks.
  • Ability to work effectively under pressure and manage multiple priorities.
  • Proficient in using accounts receivable software and other standard office software such as Microsoft Office.

by Carl Trinidad

Medical Billing Specialist - AR

Position Summary:

The Medical Billing Specialist - AR will play a vital role in our financial team with the primary responsibility of handling all aspects of claims management, from investigation to resolution. This involves reviewing and analyzing the status of claims, navigating various online portals, and regularly communicating with payers. The position also requires a proactive approach towards the investigation and analysis of claim denials, finding effective solutions to ensure their payment, and consistently following up on any outstanding claims. The Accounts Receivable Specialist will report directly to the Accounts Receivable Supervisor/Manager and contribute to the effective and efficient operation of our financial management system.

Job Details:

  • Work from home
  • Monday to Friday | 9 PM to 6 AM
  • *Following Philippine Holidays

Responsibilities:

  • Navigate Different Online Portals: Regularly access various online systems to check the status of claims, ensuring they are processed correctly and in a timely manner.
  • Communicate with Payers: Contact payer hotlines for inquiries, clarifications, and the status of claims. Display professionalism and efficiency in all interactions to maintain positive relationships.
  • Investigate Claim Denials: Proactively investigate the reasons behind claim denials, analyze the information gathered, and develop effective solutions to ensure claim payments.
  • Manage Claim Adjustments: Resubmit claims, request reprocessing, send corrected claims, and/or create appeals as needed, based on analysis and investigation results.
  • Follow Up on Outstanding Claims: Diligently and promptly follow up on any open and unpaid claim until the Accounts Receivable list is cleared up, preventing untimely resubmission or appeal.
  • Report Regularly: Provide daily reports to the Accounts Receivable Supervisor/Manager about completed tasks and any pending issues, ensuring clear and concise communication about any updates or issues that require attention.
  • Maintain the Accounts Receivable System: Regularly update the Accounts Receivable system with clear, comprehensive notes to track progress and facilitate efficient claim management.

Qualifications:

  • At least 3 years experience in an accounts receivable role, with a focus on healthcare claims management.
  • Excellent ability to navigate and use various online systems and portals.
  • Strong communication skills, both verbal and written, for effective liaison with payers and internal stakeholders.
  • Proven analytical and problem-solving skills, with the ability to analyze claim denials and devise effective resolutions.
  • Attention to detail and high levels of accuracy in all tasks.
  • Ability to work effectively under pressure and manage multiple priorities.
  • Proficient in using accounts receivable software and other standard office software such as Microsoft Office.

by Carl Trinidad

Medical Billing Specialist (AR and Collections)

Position Summary:

We are actively seeking experienced and highly motivated Medical Billing Specialist (AR and Collections) to join our dynamic team. The successful candidate will play a crucial role in managing our collection processes for TDD services. The tasks include contract analysis, reimbursement, denial management, appeals, and resolving billing-related issues with insurance companies or other responsible parties for services rendered. The ideal candidate should possess in-depth knowledge of billing and collection practices and have a strong track record in resolving complex financial situations.

Job Details:

  • Medical Billing Specialist (AR and Collections)
  • Work from home
    • Monday to Friday | 9 PM to 6 AM (Manila Time)

      Responsibilities:

      • Recognize and support patients’ rights and responsibilities in the performance of job duties, while respecting their privacy and confidentiality.
      • Follow up on submitted invoices to ensure prompt and timely payment, escalating issues as necessary.
      • Evaluate payments/denials received for correctness and ensure they are applied accordingly.
      • Identify bad debt write-offs and A/R adjustments. Initiate write-offs and adjustments in accordance with established policies and procedures.
      • Detect any overpayments and/or duplicate payments and investigate and resolve accordingly.
      • Process refund requests, in accordance with policies and procedures.
      • Maintain contact with other departments to obtain the patient or insurance information needed for claim payment.
      • Understand all procedures within regulatory mandates.
      • Ensure that the collection operations are conducted in a manner that is consistent with overall department protocol and follows Federal, State, and payer regulation, guidelines, and requirements.
      • Make calls to troubleshoot payment discrepancies and establish resolution.
      • Document, in detail, phone calls, phone numbers, persons spoken to, and call details on a consistent basis.
      • Consistently look for areas to maximize claim reimbursement.
      • Resolve issues that caused a denial within 5 days of receipt of denial.
      • Maintain strictest confidentiality; adhere to all HIPAA guidelines/regulations.
      • Understand NDC (National Drug Code) numbers, metric quantities, and knowledge of infusion supplies.
      • Maintain a broad range of knowledge of insurance plans, medical terminology, billing procedures, government regulations, and medical codes.
      • Share knowledge gained with other staff members and work as a team member.
      • Interact with others in a positive, respectful, and considerate manner.
      • Perform other job-related duties as assigned.

      Qualifications:

      • A high school diploma or general education degree (GED) equivalent.
      • At least 3 years of medical billing and collections experience.
      • Home Infusion experience, hospital or chemotherapy experience is required.
      • Experience in calculating drug units, Intrathecal Pain Management is a plus.
      • Ability to recognize, evaluate and exercise good judgment in solving complex situations and advising in accordance with laws and regulations.
      • Excellent verbal and written communication and relationship building skills with an ability to prioritize, negotiate, and work with a variety of internal and external stakeholders.
      • Strong work ethic with personal qualities of integrity and credibility.
      • Self-directed, detail-oriented, conscientious, organized, and able to follow through.
      • Ability to deal in an organized manner with problems involving multiple variables within the scope of the position.
      • Tolerance of frequent interruptions and distractions from staff and other internal support teams.
      • Proficiency in Microsoft Office, including Outlook, Word, and Excel.

      by Carl Trinidad