Sr. Claims Associates
UST
Date: 3 weeks ago
City: Taguig
Contract type: Full time
Role Description
Responsible for the accurate processing and completion of medical claims based on defined claims guidelines and policies.
Medical Claims, US Healthcare, Communication, Clinical Documentation
Responsible for the accurate processing and completion of medical claims based on defined claims guidelines and policies.
- Process new claims or modifies existing claims according to the appropriate and applicable action
- Analyze claims to determine appropriate action to approve or deny a claim for payment
- Determine accurate payment criteria for clearing pending claims based on defined policies and procedures
- Research claims edits to determine appropriate benefit application utilizing established criteria, applies physician contract pricing as needed for entry-level claims
- Reviewing and addressing provider inquiries regarding claim adjudication, and other Claims matters
- Assist and/or communicate with providers to fully understand issues and complexities of claims cases
- Demonstrate ability to work on high volume of repetitive claims
- Demonstrate increasing productivity to meet minimum requirements while maintaining quality standards
- Ready to work on a fast-paced learning process and highly engaged to complete all claims cases assigned
- Bachelor’s Degree holder preferably in the field of Nursing, Healthcare and Allied Medical Profession
- Minimum of 2 years of experience in medical claims processing experience
- Knowledge in medical coding, diagnosis coding and terminologies are an advantage but not required
- Proficient knowledge on US Healthcare Practice, Medical Coding (ICD-10, CPT4, DRG, HCPCS), Clinical Documentation Improvement, medical terminologies, EDI, and HIPAA protocols are a must
- Ability to multi-task and follow documented claims processes with minimal supervision
- Excellent verbal and written business communication skills
- Proficiency in Windows OS and Microsoft Office applications, particularly in Excel
- Strong attention to detail and the ability to make appropriate decisions based on information presented
- Amenable to working onsite and 6 months contract
Medical Claims, US Healthcare, Communication, Clinical Documentation
How to apply
To apply for this job you need to authorize on our website. If you don't have an account yet, please register.
Post a resumeSimilar jobs
IP Medical Coder - WFH
HR TechX Corp.,
Taguig
2 days ago
The Inpatient Medical Coder is responsible for reviewing, analyzing, and assigning accurate ICD-10-CM/PCS diagnosis and procedure codes to inpatient medical records. This role ensures coding compliance with all federal regulations, payer guidelines, and facility-specific policies. The ideal candidate has in-depth knowledge of inpatient coding systems and clinical documentation, and collaborates with healthcare providers to ensure accurate, complete, and compliant coding.Qualifications:With...
Technology Architect (Order Management)
Globe Telecom,
Taguig
3 days ago
At Globe, our goal is to create a wonderful world for our people, business, and nation. By uniting people of passion who believe they can make a difference, we are confident that we can achieve this goal.Job DescriptionWe are seeking a Solution Architect to join the Order Management Tribe, a team focused on designing scalable, reliable, and high-performance solutions in...
Transition Program Coordinator
Cushman & Wakefield,
Taguig
3 days ago
Job TitleTransition Program CoordinatorJob Description SummaryThe Transition Program Coordinator ensures proper coordination and documentation of activity around effective transitions and transformations. Monitors and drives project communication and activity progress. The role supports process development, program improvement, and quality initiatives for global transitions and transformations. This position is highly visible to internal & external stakeholders and will be client-facing.Job DescriptionAbout the...
