Deskripsi Pekerjaan
Join Optum, a global leader in health innovation, as an AR Follow-Up/Medical Claims Collections Specialist in Metro Manila. In this critical role, you will be the backbone of our revenue cycle management operations, ensuring that healthcare providers are accurately compensated for their vital services.
We are looking for a detail-oriented professional who thrives in a fast-paced environment and possesses a deep understanding of US healthcare billing processes. You will manage complex unpaid claims, navigate insurance denials, and execute strategic follow-ups to ensure clean claims and optimized cash flow. If you are a proactive problem solver with a passion for process improvement and financial accuracy, we want to hear from you.
At Optum, we provide a collaborative culture, opportunities for professional growth, and the tools you need to succeed in your career. Apply today to help us improve healthcare for everyone.
Tanggung Jawab
- Perform end-to-end management of insurance claims, including follow-up on unpaid accounts and aging AR.
- Analyze and resolve denied or rejected claims by collaborating with insurance payers and internal departments.
- Conduct billing reconciliation to identify discrepancies and ensure accurate posting of payments.
- Maintain thorough documentation in the billing system regarding claim status and communication with insurance representatives.
- Execute daily collection activities to meet departmental productivity and quality performance metrics.
- Stay current with evolving insurance guidelines, coding updates, and payer-specific requirements.
- Identify recurring trends in claim denials and recommend process improvements to management.
Kualifikasi
- At least 1-2 years of experience in US Healthcare Revenue Cycle Management (RCM) or Medical Billing/AR.
- Strong working knowledge of CMS-1500 and UB-04 claim forms and electronic billing systems.
- Proficiency in analyzing Explanation of Benefits (EOB) and identifying denial patterns.
- Excellent communication skills with the ability to negotiate with insurance payers via phone or portal.
- High level of proficiency in Microsoft Excel and relevant billing software.
- Strong analytical and problem-solving skills with a high degree of accuracy and attention to detail.
- Ability to work in a dynamic, target-driven environment while maintaining quality standards.