Medical Claims Analyst

JOB QUALIFICATION:

Candidates must have an experience with BPO for Healthcare account, preferably in handling medical claims, collection, credit balance management or payment posting.With background to EOB and causes of claim denials.Willing to work onsite in Ortigas, Pasig CityWilling to work on a shifting schedule

JOB DEscriptION:

Understands and resolves client work queues which include but are not limited to: claim denials/rejections for authorization, medical necessity, duplicate, timely filing, COB. Responds to incoming calls and successfully prepares and conducts outgoing, insurance calls with professionalism and helps to resolve payment issues, retrieving critical information that impacts the resolution of current or potential future claim recovery. Establishes relationships and maintains open communication with third party payor representatives in order to resolve claims issues. Reviews claim forms for the accuracy of procedures, diagnoses, demographic and insurance information, as well as all other fields on the CMS-1500 and UB-04. Reviews and corrects all claim charge denials and edits that are communicated via Epic, or other systems, Explanation of Benefits (EOB), direct correspondence from the insurance carrier or others and uses information learned to share in the education of fellow team members, to expedite the recovery of future denials and edits of the same nature. Initiates claim rebilling or corrections and obtains and submits information necessary to ensure account resolution and payments. Identifies invalid account information (i.e.: coverage, demographics, etc.) and resolves issues. Keeps informed of all federal and state mandates and managed care contract regulations, maintains working knowledge of billing mechanics in order to properly ascertain patients’ portion due by USA geographic areas. Completes all assignments per the turnaround standards. Reports unfinished assignments to the Billing Supervisor. Utilizes various resources to determine patient’s eligibility, benefits, and health plan /confirm/iation, claim status. Including online payer portals, and medical records that may result in provider or payer recoupment or rejection activity. Attends meetings and serves on committees as requested. Maintains appropriate quality audit results or achieves exemplary audit results. Meet productivity standards or consistently exceeds productivity standards. Provides and promotes ideas geared toward process improvements within the Forensics Department.  Assists the Billing Supervisor with the resolution of complex claims issues, denials and appeals.  Complies with policies and procedures as they relate to the job. Maintains strictest confidentiality of patient information and adheres to all HIPAA guidelines/regulations. Completes projects and research as assigned.