Medical Assistant - claims management (remote - ph)Somewhere

Job Title: Remote Medical ReceptionistMedical Assistant - Claims Management Specialist (Remote, Offshore)About the Role
We are seeking a highly specialized and detail-oriented Medical Assistant to focus exclusively on Claims Management and Payer Receivables. This remote, offshore role is critical for maximizing revenue recovery in a healthcare setting. You will operate as a dedicated expert responsible for monitoring, correcting, appealing, and negotiating complex insurance claims.
This is a position for a sharp critical thinker who can not only follow processes but can read between the lines of every denial to craft successful appeals. While the role is initially structured around hourly pay, high performance can lead to a consistent workload of up to 40 hours per week.Key Responsibilities
Claims Resolution & Payer Follow-Up
Claim Status Monitoring: Actively monitor the status of all billed claims to identify payment delays or denials promptly.
Rejection Correction: Analyze rejected claims, identify the root cause of the error, and swiftly correct and resubmit claims via electronic portals or payer systems.
Appeals Management: Lead the process for appealing denied claims in a timely fashion, utilizing critical thinking to understand the specific denial reason for each unique case.
Payer Communication: Conduct follow-up calls with insurance companies (payers) to aggressively pursue claim status, denial appeals, and, where applicable, assist with payment negotiations.
Technical & Operational Expertise
US Billing Knowledge (MUST HAVE): Apply working knowledge of US medical coding and billing practices, including payor names, portal usage, and the entire claims life cycle.
Coding Proficiency (MUST HAVE): Demonstrate strong knowledge of Medical Terminology, Modifier usage, CPT codes, and ICD-10 coding.
Process Oversight: Fully manage the payer receivables cycle as a dedicated expert, ensuring accountability and adherence to follow-up schedules.
Required Qualifications
Experience: Minimum of 2 years of hands-on experience in medical billing, claims management, revenue cycle management, or a similar payer receivables-focused role within a US-based healthcare setting.
Payer Expertise: Demonstrated understanding of the insurance payment and denial processes, and proven experience in effectively appealing to payors.
Communication Skills: Excellent communication skills, especially via phone, to speak professionally and persuasively with insurance companies regarding claim statuses and appeals.
Analytical Mindset: Exceptional attention to detail and strong critical thinking skills to diagnose the nuances of individual claim denials.
Basic Math Skills: Foundational proficiency in basic math required for calculating and verifying payment amounts.
Preferred Experience: Experience with claims related to Rheumatology is a significant advantage.
Certification (Bonus): A recognized Coding Certification is preferred but not required.
Compensation & Logistics
Compensation: paid hourly.
Schedule: Hourly paid role; initial hours are flexible, but consistent work up to 40 hours per week is available for proven top performers.
Structure: Remote, offshore position.
Somewhere

Metro Manila
Permanent
Full-time