claims AnalystGenesis Orthopedics & Sports Medicine

Claims AnalystRemote/Full-timeJoin Our Mission at Genesis Orthopedics & Sports Medicine!At Genesis Orthopedics & Sports Medicine, we believe high-quality orthopedic care should be accessible to all-not just those who can afford it. After 17 years of conventional practice, we took a step back, challenged the status quo, and reimagined healthcare delivery. Over four years, through hundreds of hours of research, global case studies, and bold innovation, we developed a new model that maintains our reputation for exceptional care while making our services more ethical and affordable.Key Responsibilities
Operations & Oversight
Review and validate all contractual adjustments and ensure accuracy in claim posting and payer compliance.
Download and allocate new accounts to analysts from multiple EPIC workqueues based on payer, aging, and priority.
Audit processed claims for accuracy, completeness, and timeliness before submission or follow-up.
Perform quality checks and ensure analysts follow correct claim handling procedures.
Conduct daily and weekly performance reviews, tracking productivity and accuracy metrics.
Team Management
Lead and support a team of claims analysts, providing guidance, performance feedback, and escalation support.
Review and summarize EOD (End of Day) and EOW (End of Week) reports to evaluate team output and resolve discrepancies.
Manage task assignments, track turnaround times, and balance workloads across analysts.
Provide training and corrective coaching when errors or trends are identified.
Claims & Denial Management
Oversee denial trending and root cause analysis for all orthopedic-related claims.
Identify and escalate systemic issues such as incorrect coding, missing documentation, or payer configuration errors.
Work closely with billing, coding, and authorization teams to resolve high-value or high-impact claims.
Ensure claims are submitted, followed up, and appealed in accordance with payer guidelines and timely filing limits.
Analytics & Reporting
Prepare and distribute daily, weekly, and monthly reports on claim status, denial trends, and AR performance.
Monitor KPIs such as denial rate, claim turnaround time, and first-pass resolution rate.
Track performance metrics for the entire team and provide data-driven recommendations for improvement.
Compliance & Continuous Improvement
Ensure all claim activities comply with HIPAA, payer rules, and internal SOPs.
Stay current with orthopedic coding changes, payer updates, and EPIC workflows.
Recommend and implement process improvements to enhance claim accuracy and reduce rework.
Participate in audits and provide supporting claim documentation when required.
RequirementsQualifications
3-5 years of experience in medical claims management or billing, with a strong focus on orthopedic claims.
Proven experience managing or leading a claims or AR team in a healthcare setting.
Hands-on experience with EPIC system is required.
Excellent understanding of CPT/HCPCS codes, modifiers, EOBs, ERAs, CARC/RARC codes, and payer-specific denial handling.
Advanced Excel skills (pivot tables, lookups, trend tracking).
Exceptional attention to detail and strong problem-solving abilities.
Excellent communication skills and ability to work cross-functionally with billing, coding, and management teams.
BenefitsWhy Choose Genesis?Supportive Team - Be part of a compassionate and professional healthcare team that values collaboration.Competitive Compensation - Enjoy a strong base salary with opportunities for performance-based bonuses.Meaningful Impact - Help us revolutionize healthcare by making top-tier orthopedic care accessible to everyone.Apply today and be part of something truly transformative at Genesis Orthopedics & Sports Medicine.
Genesis Orthopedics & Sports Medicine

Metro Manila
Permanent
Full-time