Revenue Cycle & Authorizations Specialist – Podiatry Clinic

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

📋 Description

• Oversee comprehensive follow-ups on unpaid, underpaid, and denied claims as part of accounts receivable aging reports.

• Act as the primary expert for two key HMO plans by investigating rejection reasons, resubmitting corrected claims, filing appeals, and addressing administrative obstacles.

• Handle routine Medicare and PPO denials to maintain minimal aging across simpler payer categories.

• Process, monitor, and reconcile around 200 claims weekly.

• Conduct insurance eligibility and coverage verifications before patient appointments.

• Submit, track, and obtain prior authorizations from commercial and managed care payers.

• Relay authorization statuses, limitations, and approval updates to clinical staff.

• Make numerous follow-up calls to HMO representatives, medical groups, and clearinghouses to resolve claim holds.

• Engage with patients to explain insurance coverage regulations, outstanding balances, and necessary authorization procedures.

⛳️ Requirements

• A minimum of 2 years of experience in medical billing, accounts receivable management, and insurance prior authorizations.

• Strong understanding of HMO medical group referrals, capitation/FFS structures, and HMO-specific appeal processes.

• Familiarity with CPT, ICD-10, HCPCS codes, modifiers, and CMS-1500 claim formats.

• Proven capability to handle a consistent workload of about 200 claims weekly while maintaining accuracy.

• High degree of punctuality and dedication to upholding the established 38-hour weekly work schedule.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health, dental, and vision insurance plans.

• Opportunities for professional development and continuing education.

• Supportive work environment with a focus on employee well-being.