Deskripsi Pekerjaan
Are you a detail-oriented professional with a passion for healthcare revenue cycle management? Optum is seeking a high-performing US Medical Claims Specialist to join our growing team in Metro Manila. In this critical role, you will be the backbone of our financial operations, ensuring that provider-side medical claims are processed accurately, denials are resolved effectively, and accounts receivable (AR) are managed to optimize cash flow.
As part of the Optum team, you will navigate complex billing systems, interact with insurance payers, and utilize your analytical skills to resolve claim rejections. We are looking for an individual who thrives in a fast-paced environment and possesses a deep understanding of US healthcare billing practices. If you are ready to advance your career with a global healthcare leader, we want to hear from you.
Tanggung Jawab
- Manage end-to-end accounts receivable (AR) follow-up processes for US-based medical claims.
- Conduct thorough research and analysis on unpaid claims and perform necessary corrections for resubmission.
- Proactively communicate with insurance payers to resolve denials and maximize reimbursement rates.
- Perform billing reconciliation to ensure accuracy between provider records and insurance payments.
- Maintain high levels of accuracy in documentation, adhering to HIPAA compliance and strict privacy regulations.
- Collaborate with internal teams to identify trends in claim denials and propose process improvements.
- Meet or exceed daily production and quality targets in a high-volume processing environment.
Kualifikasi
- Minimum of 1-2 years of experience in US Medical Billing, specifically in AR Follow-up or Collections.
- Strong understanding of CPT, ICD-10, and HCPCS coding standards.
- Proven ability to interpret Explanation of Benefits (EOB) and Electronic Remittance Advice (ERA).
- Excellent command of the English language, both written and verbal, for effective payer communication.
- Proficiency in Microsoft Office Suite (especially Excel) and experience with industry-standard EMR/Billing software.
- Exceptional attention to detail and ability to troubleshoot complex billing discrepancies.
- Strong organizational skills with the ability to manage time effectively in a results-driven environment.