Medical Biller Appeals Specialist - Work From Home

Location: Mandaluyong,Metro Manila,Philippines

ClinicMind, the nation’s leader in multi-specialty Electronic Healthcare Records (EHR) software and Revenue Cycle Management (RCM) services, is looking for a Medical Biller AR Followup Analyst. If you’re excited to be part of a winning team, ClinicMind is a perfect place to get ahead.

RESPONSIBILITIES

1. Maximize insurance reimbursement for healthcare practice owners

2. Discover root causes for medical insurance claim denial, underpayment, or delay and propose resolutions

3. Interact with the US-based insurance carriers to:

• follow-up on unpaid claims, delayed processing, and underpayment

• plan and execute medical insurance claim denial appeal process

QUALIFICATIONS

1. Minimum of 6 months experience in US-based AR follow-up and appeals process

2. Familiar with US medical insurance industry and insurance claims processing cycle

3. Knowledge of ICD-10, CPT, and HCPC

4. Understand CMS-1500 and UB-04 claim formats

5. Excellent listening, communication, and problem-solving skills

6. Self-motivated and able to work autonomously

ESSENTIAL FUNCTION

1. Appeals process, rules, and regulations for each insurance

2. Knowledge Timely Filing limits for each insurance

3. Extended knowledge of Appeals process thru payer portals

4. Knowledge of EOBs and contractual allowable amounts

5. Knowledge of Medicaid and Medicare coverages

6. Verify eligibility and benefits

7. Understand Medicare and Medicaid rates

8. Excellent written and verbal communication skills

MUST HAVE

1. High comfort level working on Eastern Time Zone/US Shift

2. Good internet access at home

3. Mobile Hotspot

4. Laptop/Desktop of at least 8 GB