Insurance Denials & Payment Specialist

Remote

Full Time

Billing

Mid Level

Payment Posting & Denial Management Specialist
RML-PH - Quezon City (Remote)

Please note: Submitting multiple applications for the same position may delay your review of your candidacy. We encourage you to apply once and ensure all information is complete and accurate.

About Us

RML-PH is a dynamic and innovative Health Solutions and Care Delivery Organization committed to transforming the healthcare landscape. With a mission to provide accessible, high-quality healthcare services and cutting-edge solutions, RML-PH focuses on holistic patient care and embraces the latest advancements in health technology. Our team is dedicated to providing top-tier customer care, leveraging expertise and technology to exceed expectations. Join us at RML-PH to be part of a dynamic team committed to delivering excellence in healthcare customer service.

Position

We are seeking a skilled and detail-oriented individual to join our team as an Insurance Denials & Payment Specialist. This role combines responsibilities for accurate and timely processing of payments as well as resolving denied insurance claims. You will play a key role in ensuring financial accuracy and resolving billing discrepancies. The role requires strong attention to detail and excellent problem-solving abilities. You will work closely with insurance companies, doctors/facilities, and internal departments to follow up on outstanding claims and support accurate payment posting.

Responsibilities:

Accurately post payments received from insurance companies, patients, and other payers into the billing system
Review and resolve payment discrepancies to ensure accurate posting
Reconcile payments with remittance advice and explanation of benefits statements
Investigate and resolve claim denials, identifying the reason for denial (e.g., coding errors, eligibility issues, incomplete documentation)
Conduct research and gather supporting documentation to address denial reasons and resubmit claims
Update claim information (e.g., diagnosis codes, CPT codes, and modifiers) and submit appeals when necessary
Write and submit appeals with supporting documentation to justify claims when necessary
Stay updated on changes in billing regulations and ensure compliance with state and federal guidelines
Maintain accurate records and documentation of payment postings, adjustments, and corrections
Collaborate with the billing and accounts receivable team to resolve outstanding balances and discrepancies
Ensure compliance with regulatory guidelines and HIPAA regulations
Additional responsibilities as required to meet business needs.

Qualifications:

High school diploma or equivalent; additional certification or education in healthcare or a related field is preferred
Certification or experience as a medical coder is preferred.
Minimum of 2 years of experience in payment posting, denial management, and/or medical billing in a hospital or healthcare setting
Proficient in medical billing software, electronic health records (EHR), and electronic payment systems; working knowledge in AdvancedMD software is preferred
Strong knowledge of ICD-10, CPT, and HCPCS coding systems, and insurance plans (Medicare, Medicaid, private insurance)
Excellent attention to detail and ability to maintain accuracy in a fast-paced environment
Strong analytical and problem-solving skills, with the ability to resolve payment discrepancies and claim denials
Effective communication skills in English, both written and verbal
Ability to work independently and as part of a team
Familiarity with HIPAA regulations and compliance requirements

How to Apply:
Interested candidates are encouraged to submit their resumes and a cover letter outlining their qualifications and how they would contribute to RML-PH's success via LinkedIn.

Additional Details:

Ideal start date: As soon as the right fit is found
Schedule: Monday to Friday, 10:00 PM to 7:00 AM
Work Location: Remote (Quezon City, PH)
Job Type: Full-time
Salary: Php 35,000-45,000 per month

Benefits:

Equipment provided
Contributions to PhilHealth, SSS, and Pag-IBIG
Paid leave: Sick, Paternity, Annual, Public holidays
Monetary compensation: 13th-month pay and overtime
New hires begin as contractors for the first two months before being reviewed for direct employment

Requirements:

All employees must undergo a background check, and continued employment is dependent on its outcome
English proficiency required

At RML-PH, we care for our team members and their well-being. We are an equal-opportunity employer and value diversity, striving to create an inclusive workplace for all. We encourage candidates of all backgrounds and experiences to apply.

Disclaimer:
All positions at RMLPH require a background check during the onboarding process. Continued employment is dependent on the outcome of the background check.

RML-PH does not partner with staffing agencies. Resumes submitted unsolicited by agencies will not be considered, and RML-PH assumes no responsibility for fees incurred.

Please view this job listing on LinkedIn for an up-to-date status. Other job sites may repost our listings but do not always remove them once filled.

https://www.linkedin.com/company/rmlph
https://rmlph.applytojob.com/apply/

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