US Medical Claims Specialist (AR Follow-up/RCM) - Day 1 HMO + Retirement Plan

Job Description

Job Qualifications:

• Completed at least 2 years of college.
• Minimum 12 months experience in Healthcare Account Receivable/Collections in a BPO setting.
• Familiarity with UB Claims and UB04 forms.
• Experience in medical billing/AR collections.
• Background in calling insurance (Payer) for claim status and payment disputes.
• Familiar with EPIC SYSTEM.
• Willing to work on-site in Quezon City, or Makati.
• Experience in a BPO Healthcare Account is required.

Primary Responsibilities:

• Read contracts for payment disputes.
• Work on the provider side.
• Verify claim status and collect unpaid claims from insurance.
• Process claims payments, manage denials, and track claim statuses.
• Manage collections for healthcare unpaid claims.
• Interact with customers to ensure invoice accuracy and resolve claims discrepancies.
• Provide input on policies, systems, methods, and procedures for premium collection management.
• Educate customers on online applications for claims and payments.
• Monitor outstanding balances and ensure clients pay as billed.
• Prepare invoices and reconcile billing with accounts receivables.
• Conduct quality assurance and audits of collection activities.
• Handle documents, emails, and calls related to account processes.
• Perform accounts receivable collections, follow-up, denial management, claims payment processing, tracking, and appeals for hospital processes.

Your role is critical in providing confidence in the exceptional care we offer to our members, families, facilities, and health professionals. This is an everyday opportunity to do your life's best work.

• Market Competitive Pay Levels
• Fast Processing! No Exam Hiring
• Retirement Plan
• Medical Plan (HMO) from Day 1 of employment
• Dental, Medical, and Optical Reimbursements
• Life and Disability Insurance
• Paid Time-Off Benefits
• Sick Leave Conversion
• Tuition Fee Reimbursement
• Employee Assistance Program (EAP)
• Annual Performance Based Merit Increases
• Employee Recognition
• Training and Staff Development
• Employee Referral Program
• Employee Volunteerism Opportunity
• All Mandatory Statutory Benefits

• Optum is the health care technology and innovation company of the UnitedHealth Group enterprise along with UnitedHealthcare.
• UnitedHealth Group is a health care and well-being company with a mission to help people live healthier lives and help make the health system work better for everyone.
• We're a leading health solution and care delivery organization. Our work is complex, but our mission is simple: create a healthier world, with you at the center.
• As part of a Fortune 5 enterprise, we are improving the health care experience of over 125 million people around the world.
• We're a diverse team with operations across North America, South America, Europe, Asia Pacific and the Middle East. This includes our over 25,000 employees in the Philippines.
• Elevate your career with a leading health care company while improving lives.

Join us in evolving health care so everyone can have the opportunity to live their healthiest life. This is your opportunity to be part of a team that's dedicated to Caring. Connecting. Growing together

• Cafeteria, Office gym, Maternity leaves, Paternity leaves, Professional degree assistance, Joining bonus, Retirement benefits, Health & insurance, Health insurance, Life insurance