Customer Service Representative - Healthcare Insurance (Collections/Payment Review) McKinley Taguig

RESPONSIBILITIES:

Ø Performs AR follow-up on assigned accounts taking into account Timely Filing Limits set by the payer.

Ø Submits adjustments or write-off requests for approval to resolve outstanding account balances.

Ø Submits medical record packets for submission to the payer for claims reprocessing, reconsideration or appeal requests.

Ø Receives inbound calls/ call backs from payers/insurances regarding accounts that they are actively working on.

Ø Resolves claim rejections accordingly in order to release a clean claim to the payer.

Ø Responds to e-mail inquiries from different departments regarding pending insurance balances or claim denials.

Ø Maintains accurate and detailed notes/documentation in applicable systems.

Ø Keeps Supervisor and/or Manager informed of system issues.

Ø Observes legal and ethical guidelines for safeguarding patient and company confidentiality (HIPAA)

Ø Other duties as assigned.

 BASIC QUALIFICATIONS | EDUCATION:

Ø Completed at least 2 years in College or with an Associate or Bachelor’s Degree

Ø Excellent oral and written communication skills

Ø Thorough understanding of the US Healthcare Insurance claims

PREFERRED QUALIFICATIONS:

Ø Proficient Medicare and solid general payer knowledge

Ø Has the ability to read and interpret explanation of benefits

Ø Basic Excel, Word and Outlook experience required

Ø Typing using computer keyboards, 10-key pads and calculators

Ø Strong Computer/Software Skills

Ø Detail-oriented

Ø Typing speed of 35 wpm

Ø Occasional weekend work may be required

Ø Must be flexible to work on a night shift (between 6pm to 10am) Philippine Standard Time.

Ø Must be amenable to work on Overtime or during Rest Days when business requests for additional (paid) hours

COMPETENCIES:

Ø Internal – At least 1 year tenure in ACH

Ø External – 1 year of experience in Healthcare Insurance Collections and/or Correspondence