Requirements:

• Graduate of any college degree.
• Must have 2+ years in a Healthcare BPO setting
• Knowledge of commercial, HMO, Medicare/Medicaid, and other payer requirements.
• Working knowledge on the use of insurance payer websites ie: Availity, Optum, Medicare, Evicore portals.
• Working knowledge with Practice Management systems, preferably KAREO a plus.
• Effective communication abilities
• Proven problem-solving skills
• Proficient knowledge of medical terminology is likely to be encountered in medical claims denials.
• Amenable to work onsite during training and nesting period in Alabang, Muntinlupa City and US shifts 

Responsibilities

• Monitor outstanding accounts to ensure timely collection of payments.
• Maintain accurate aging reports for all outstanding invoices.
• Prioritize accounts based on age, value, or client-specific requirements.
• Follow-Up on Outstanding Claims/Invoices
• Contact insurance companies, clients, or customers via phone, email, or portals to check claim status or payment status.
• Identify delays, denials, or issues affecting payment.
• Document all follow-up actions in the system.
• Denial Management & Resolution
• Investigate claim denials and underpayments.
• Work with billing teams to correct and resubmit claims.
• Appeal denied claims with proper documentation when necessary.
• Payment Posting Support
• Coordinate with payment posting teams to verify payment accuracy.
• Resolve discrepancies between posted payments and expected reimbursements.
• Communication & Coordination
• Collaborate with billing, coding, and customer service teams to resolve issues.
• Communicate with insurance providers or clients to clarify requirements or missing information.
• Customer Service
• Provide clear and respectful communication to clients or insurers.
• Address inquiries related to billing or outstanding balances.
• Process Improvement
• Identify frequent denial trends or process bottlenecks.
• Suggest improvements to reduce AR days and denial rates.