Customer Service Representative - Healthcare

The representative is responsible for collections, account follow up, billing and allowance posting for the accounts assigned to them.

Duties and Responsibilities :

Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or websites.

Meets and maintains daily productivity / quality standards established in departmental policies.

Uses the workflow system, client host system and other tools available to them to collect payments and resolve accounts.

Adheres to the policies and procedures established for the client / team.

Knowledge of timely filing deadlines for each designated payer.

Performs research regarding payer specific billing guidelines as needed.

Ability to analyze, identify and resolve issues causing payer payment delays.

Ability to analyze, identify and trend claims issues to proactively reduce denials.

Communicates to management any issues and / or trends identified.

Initiate appeals when necessary.

Ability to identify and correct medical billing errors.

Send appropriate appeals, accurate requesting information, supporting documentation, and effective communication to complete recovery process.

Understanding of under or over payments and credit balance processes.

Assist with special A / R projects as needed. Analytical skills and the ability to communicate results are required.

Act cooperatively and courteously with patients, visitors, co-workers, management and clients.

Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.

Qualifications :

Completed at least High School education

With minimum 1 year of US Healthcare Account Receivable / Collections in a BPO setting or environment (claims payments processing, claims status and tracking, Medical Billing, AR Follow ups, Denials and Appeals-outbound healthcare providers)

Experienced on medical billing / AR Collections.

Background in calling insurance (Payer) to verify claim status and payment dispute.

Must be amenable to work night shifts.

Must be amenable to work onsite in Ortigas, Pasig.