Medical Billing Specialist – Denial Management

This is a fully remote position, open to applicants in Philippines.

📋 Description

• Take ownership of rejections, denials, and denied claims processes from identification to resolution.

• Conduct daily monitoring of ERA activities and execute same-day follow-ups on denials and rejections.

• Enhance the Net Collection Rate and improve payer turnaround times.

• Oversee reprocessing timelines and ensure the prompt resubmission of corrected claims.

• Investigate the root causes of denials and coordinate corrective measures across various teams.

• Process denied, underpaid, and unpaid claims through payer portals, phone calls, and written appeals.

• Analyze trends in denials based on payer, authorization, coding, documentation, or eligibility issues.

• Collaborate with billing, credentialing, clinical, and operations teams to eliminate revenue obstacles.

• Maintain precise denial tracking, follow-up notes, and documentation of resolutions.

• Proactively escalate high-risk or aging denials.

• Assist with communication with payers via phone, portal, fax, and email.

• Contribute to process improvement initiatives aimed at minimizing future denials and revenue loss.

⛳️ Requirements

• Bachelor’s degree or equivalent experience is required.

• Exceptional attention to detail and strong organizational abilities.

• Experience in a call center or high-call-volume operational setting.

• Minimum of 3 years in healthcare billing, collections, denials, or revenue cycle management.

• Familiarity with US-based commercial and government health insurance payers.

• In-depth understanding of denials, rejections, EOBs, ERAs, and claims reprocessing workflows.

• Strong communication skills and problem-solving capabilities.

• Comfortable managing payer calls and navigating payer portals.

• Proficient in MS Office, billing systems, and operational tools.

• Ability to juggle multiple priorities and meet deadlines in a fast-paced environment.

🏝️ Benefits

• This position is remote. We are seeking candidates located outside of the United States who can work within United States East Coast time zones.