Medical Direct Billing Senior Officer
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Job Description
ONLY FILIPINO NATIONALS NEED APPLY
Job Purpose:
We are seeking an experienced Senior Officer Direct Billing to join our medical insurance team. The role is responsible for managing and processing direct billing claims ensuring compliance with policy terms medical necessity and regulatory requirements. The ideal candidate will have strong technical knowledge in the field of medical insurance claims adjudication and medical coding while contributing to efficient claims settlement and enhancing providers satisfaction.
Key Responsibilities:
- Process and review direct billing claims from the network providers for accuracy medical necessity and policy compliance.
- Validate coding (ICD CPT HCPCS) and provider submissions.
- Liaise with providers to resolve discrepancies and gather required information.
- Identify claim irregularities fraud or overutilization and escalate as needed.
- Ensure compliance with internal policies regulations and benefits.
- Support audits analyze billing trends and prepare reports.
- Coordinate with Finance and teams to ensure timely settlements within TAT.
- Mentor junior staff and contribute to process improvements.
Educational Qualifications:
Bachelors degree in Allopathic medicine health science Pharmacy Physiotherapy Nursing Dentistry or a related medical/paramedical field.
Experience:
Minimum 3 - 5 years of experience in medical claims processing of direct billing provider claims.
Key Skills:
- Strong knowledge of medical treatments billing and terminology.
- Skilled in reviewing claims and validating coding accuracy.
- Clear communication and negotiation with providers and stakeholders.
- High attention to detail in claims adjudication.
- Ability to detect trends irregularities and fraud.
- Leadership skills to mentor and guide junior staff.
Employment Type
Full Time
