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Medical Claims and Returns Specialist

at Visaya KPO
Published October 2, 2024
Expires October 17, 2024
Location Pasig, Philippines
Category Healthcare  
Job Type Full-time  

Description

Duties & Responsibilities

  • Review refund and overpayment requests from patient to determine if overpayment has occurred
  • Review and resolve credit balances through credit transfers, account corrections and refund request form completion for manual refund check requests
  • Identify root causes and trends contributing to patient and insurance credit balances
  • Proactively work with other revenue cycle departments to improve efficiency and reduce and/or eliminate refund issues
  • Posts debits for approved refunds
  • Research returned checks and collaborates with A/P for reporting to unclaimed property
  • Resolves Department credit balance inquiries for transfers and refund check requests
  • Ability to work collaboratively and build positive business relationships with clinical areas and the payer community
  • Develop and maintain expertise with payer specialty-specific payment policies
  • Maintain and respect the confidentiality of patient information in accordance with insurance collection guidelines and corporate policy and procedure
  • Preform special projects as required

Qualifications & Competencies

  • BA/BS in accounting, business, finance or an equivalent combination of training and experience is necessary
  • 3 years’+ experience in health care /managed care environment, preferably in a large physician practice or a combination of experience and education
  • 1 year+ of experience with complex refunds
  • Knowledgeable in physician reimbursement and managed care claim payment issues.
  • Excellent communication skills and ability to effectively communicate with various levels of management in a multi-disciplinary environment
  • Understanding of electronic medical record and billing system Pricing Module and fee schedules
  • Strong analytical skills with attention to detail
  • Advanced level Excel and financial analysis related to physician reimbursement
  • Ability to do math calculations, input data into the computer, and analyze data as requested.
  • Must have at least 6 months of epic tool experience.
  • Must be willing to work onsite in Ortigas, Pasig City.

Enjoy the ff. Perks and Benefits:

  • 15% Night Differential
  • HMO Benefits after 30 days + Add Up to 2 Dependents
  • Retirement Benefits
  • 24 Leave Credits per year, Convertible to Cash
  • Wholistic Employee Wellness Program
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