Duties & Responsibilities

• Verify/obtain eligibility and/or authorization utilizing payer web sites, client eligibility systems or via phone with the insurance carrier/providers
• Update patient demographics/insurance information in appropriate systems Research/ Status unpaid or denied claims
• Monitor claims for missing information, authorization, and control numbers (ICN//DCN)
• Research EOBs for payments or adjustments to resolve claim
• Contacts payers via phone or written correspondence to secure payment of claims Access client systems for payment, patient, claim and data info
• Follows guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systems
• Secure needed medical documentation required or requested by third party insurance carriers.
• Maintain confidentiality of patient information in accordance with insurance collection guidelines and corporate policy and procedure
• Perform other related duties as required
• Utilize provider billing manuals to obtain billing guidelines and requirements.
• Write appeal letters for technical appeals
• Verifies accuracy of underpayments utilizing contracts and claims data.
• Prepares claims for clinical audit processing in the case of authorization, coding, level of care and/or length of stay denials
• Utilizes reports for analysis and to monitor follow up activities and prioritization
• Assists organization with working through special projects as needed
• SME for colleagues and provide direction for resolution of accounts
• Assists in new hire training
• Assists in content building of training materials

Qualifications & Competencies

• 3+ years of medical collections/billing experience
• 2+ years of experience as a Team Leader
• Intermediate knowledge of ICD-10, CPT, HCPCS and NCCI
• Expert knowledge of third-party billing guidelines
• Expert knowledge of billing claim forms (UB04/1500)
• Expert knowledge of payor contracts
• Working Knowledge of Microsoft Word and Excel
• Intermediate working knowledge of health information systems (i.e., EMR, Claim Scrubbers, Patient Accounting Systems, etc.)
• Must be willing to work onsite in Ortigas, Pasig City