Billing Specialist

About the Role

This organization specializes in recruiting top-tier remote professionals based in the Philippines and Latin America, utilizing a stringent screening process to guarantee high-level English skills and technical proficiency. Operating across sectors like finance, real estate, and healthcare, they provide both direct hiring and managed service solutions. As a Billing Specialist within the healthcare division, you will manage revenue cycle tasks independently. You will work remotely under the supervision of the Head of Revenue Cycle Management, focusing on enhancing financial performance by resolving complicated denials, handling prior authorizations, and increasing the volume of accurate, clean claims to clear existing backlogs.

Requirements

• You should possess two to five years of revenue cycle experience on the provider side, specifically in an outpatient, clinic, or practice environment.
• You must have direct experience managing denials, including appeal writing and correcting claim information, as well as submitting and monitoring prior authorizations.
• You are required to understand denial codes, payer IDs, NPI, and provider enrollment standards.
• You must be skilled in RCM software or clearinghouse tools such as Waystar, Candid Health, Change Healthcare, or Availity.
• You need to demonstrate C2-level English fluency to communicate effectively with payers and patients.
• You will have an advantage if you bring prior experience in team leadership, CPT coding, or Medicaid billing.

Responsibilities

• You will process daily denial lists within the Candid system, create and file appeals, and establish strategies to prevent ongoing claim issues.
• You will manage the prior authorization process, focusing on Medicaid plans, while documenting updates and updating scheduling teams and providers.
• You will investigate and resolve obstacles before submission, such as inaccurate provider enrollment or absent payer IDs.
• You will update and maintain performance dashboards regarding clean claim rates, claim processing speed, and accounts receivable duration.
• You will prepare routine reports on backlog status, brief management on denial trends, and reach out to families or patients to secure necessary documentation.

Benefits & Perks

• You will receive a competitive salary commensurate with your experience and the ability to work remotely from any location in the Philippines.
• You will be eligible for HMO coverage following the completion of three months of full-time employment, in addition to extensive paid time off.
• You will benefit from professional development through mentorship from global industry leaders, access to training resources, and chances for international networking.
• You will have the opportunity to earn performance-based rewards and recognition, particularly for maintaining high standards in reporting and CRM data management.