Medical Claims Analyst - Accounts Receivable
Full-time
Risewave Consulting Inc.
The Medical Claims Analyst is responsible for collections, account follow-up, billing, and
allowance posting for assigned accounts. The role ensures accurate, timely resolution of outstanding claims through proactive follow-up and analytical problem-solving.
Responsibilities:
- Follow up with payers via phone, email, fax, or payer portals to ensure timely resolution of outstanding claims.
- Meet and maintain daily productivity and quality standards.
- Use workflow systems, client host systems, and other tools to collect payments and resolve accounts.
- Adhere to all client and team policies and procedures.
- Maintain knowledge of timely filing deadlines for designated payers.
- Research payer-specific billing guidelines as needed.
- Analyze and resolve issues causing payer payment delays.
- Identify trends in claim issues to proactively reduce denials.
- Communicate identified issues and trends to management.
- Initiate and process appeals when necessary.
- Identify and correct medical billing errors.
- Prepare and send accurate appeal documentation and supporting records.
- Understand underpayments, overpayments, and credit balance processes.
- Assist with special A/R projects as needed; strong analytical and communication skills required.
- Maintain cooperative and courteous communication with patients, visitors, coworkers, management, and clients.
- Protect and handle PHI in accordance with HIPAA standards.
- Work independently using assigned work queues.
- Maintain confidentiality and professionalism at all times.
- Perform other duties as assigned by management.
Qualifications:
- Must be willing to work night shifts/shifting schedule in Ortigas, Pasig (Full Onsite).
- Completed at least High School education.
- Minimum of 1 year of Healthcare Accounts Receivable/Collections experience in a BPO environment (claims payment processing, status/tracking, medical billing, AR follow-ups, denials, appeals).
- Experience in Medical Claims/Billing and AR collections.
- Background in calling insurance payers to verify claim status and resolve payment disputes.
Vacancy posted 16 days ago
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