Deskripsi Pekerjaan
Are you detail-oriented and looking for a pivotal role in the healthcare industry? Sales Rain BPO Inc. is seeking a dedicated Claims Analyst - Post Pay Audit to join our dynamic team in Metro Manila. In this essential position, you will be responsible for ensuring the financial accuracy and integrity of our operations by conducting thorough post-payment audits of insurance claims.
As a Claims Analyst, you will serve as a key bridge between our internal review teams and external payors. Your expertise will be vital in identifying discrepancies, reviewing medical records, and preparing comprehensive audit packets for reconsideration. We offer a collaborative work environment, competitive benefits, and ample opportunities for professional growth within the BPO sector.
Tanggung Jawab
- Conduct comprehensive post-pay audits of insurance claims to identify errors, omissions, and potential overpayments.
- Review medical records and coding documentation to ensure strict compliance with payer guidelines and regulations.
- Prepare and submit detailed audit packets for internal review or external payor reconsideration.
- Communicate effectively with external payors to resolve claim discrepancies and negotiate necessary adjustments.
- Maintain accurate and up-to-date records of all audit activities, findings, and communication logs in the database.
- Ensure strict adherence to all company policies, healthcare regulations, and compliance standards during the audit process.
- Collaborate with the broader claims processing team to improve overall audit accuracy and operational efficiency.
Kualifikasi
- Bachelor’s degree in Nursing, Medical Technology, Health Information Management, Accounting, or a related field.
- Previous experience in healthcare claims auditing, medical coding, or revenue cycle management is highly preferred.
- Familiarity with medical coding systems such as ICD-10 and CPT is a strong advantage.
- Strong attention to detail and the ability to detect subtle errors in complex data sets.
- Excellent written and verbal communication skills for interacting with external payors.
- Proficiency in using MS Office applications, particularly Excel, for data analysis.
- Ability to work independently and meet tight deadlines in a fast-paced BPO environment.