[Hiring] Medical Billing & Claims Processor @RML-PH

Role Description

We are seeking a highly motivated and detail-oriented individual to join our team as a Medical Billing & Claims Processor. In this role, you will play a critical part in ensuring accurate and timely billing, as well as claims processing and follow-up. You will work closely with insurance companies, doctors/facilities, and internal departments to manage the entire billing and claims lifecycle, from initial submission to follow-up and resolution.

• Compile necessary information, including patient demographics, insurance information, provider details, and procedural codes
• Analyze, prepare, and submit medical claims to insurance payers through our electronic billing system
• Assign and enter appropriate CPT and ICD-10 codes on claims
• Investigate and resolve payment discrepancies, coordinating with other departments when necessary
• Maintain accurate records of billing and claim activities, ensuring compliance with payer guidelines and company policies
• Stay up-to-date on billing regulations and implement process improvements
• Participate in internal meetings and training sessions to stay informed of industry updates
• Effectively manage patient calls or inquiries related to insurance claims and balances
• Monitor the status of submitted claims to resolve rejections or delays and resubmit as needed
• Follow up on unpaid insurance claims by checking insurance portals or contacting insurance customer service

Qualifications

• High school diploma or equivalent; additional certification or education in healthcare or a related field is preferred
• Certification or experience as a medical coder is preferred
• 2+ years of experience in medical billing, claims processing, or a related field
• Proficient in medical coding systems and terminology (CPT, ICD-10, HCPCS)
• Working knowledge of AdvancedMD software is preferred
• Strong knowledge of insurance billing procedures and payer guidelines (Medicare, Medicaid, private insurance)
• Experience using electronic medical records (EMR) and billing software
• Strong attention to detail, with excellent analytical and problem-solving skills
• Ability to multitask and prioritize in a fast-paced environment
• Effective communication skills in English, both written and verbal
• Ability to work independently and collaborate with team members to resolve issues
• Familiarity with HIPAA regulations and compliance requirements

Requirements

• WFH Equipment is expected to be provided by the candidate
• All employees must undergo a background check, and continued employment is dependent on its outcome
• English proficiency is required

Benefits

• Contributions to PhilHealth, SSS, and PAG-IBIG
• Paid leave: Sick, Paternity, Annual, and Public holidays
• Monetary compensation: 13th-month pay and overtime
• New hires begin as contractors for the first two months before being reviewed for direct employment