Medical Assistant Denial & Claims Management (Remote PH)
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Job Location:
National Capital Region - Philippines
Monthly Salary:
Not Disclosed
Posted on:
30+ days ago
Vacancies:
1 Vacancy
Job Summary
Job Title: Remote Medical Receptionist
We are seeking a highly specialized and detail-oriented Medical Assistant to focus exclusively on Denial /Claims Management and Payer Receivables.
Top Priority: Denial Management & Appeals (Primary Focus)
Other responsbilities:
Medical Assistant - Denial & Claims Management Specialist (Remote Offshore)
About the RoleWe are seeking a highly specialized and detail-oriented Medical Assistant to focus exclusively on Denial /Claims Management and Payer Receivables.
This remote offshore role is critical for maximizing revenue recovery in a healthcare setting. You will monitor correct appeal and negotiate complex insurance claims. The role is initially hourly; high performance can lead to a consistent workload of up to 40 hours per week.
Key Responsibilities:Top Priority: Denial Management & Appeals (Primary Focus)
- Denial Analysis & Strategy: Review denial reasons line-by-line interpret payer policies/NCCI edits and craft targeted appeal strategies for each case.
- Appeals Ownership: Draft persuasive evidence-based appeal letters; compile supporting documentation; submit within timely-filing/appeal limits; track outcomes.
- Rejection/Resubmission: Identify root causes of rejections (coding eligibility modifiers documentation) correct accurately and resubmit via clearinghouse/payer portals.
- Payer Communication: Proactively call payers to obtain status challenge denials clarify policy and negotiate payments or reconsiderations when applicable.
- Denial Trending: Surface recurring denial patterns and recommend upstream fixes (coding documentation workflows training).
Other responsbilities:
- Claim Status Monitoring: Actively track all billed claims to identify payment delays or denials promptly.
- Payer Follow-Up: Conduct regular follow-ups via portals and phone to drive claims to resolution.
- Process Oversight: Fully manage the payer receivables cycle as a dedicated expert ensuring accountability and adherence to follow-up schedules.
- Documentation & Tracking: Maintain clear notes next actions and dates across EMR/PMS clearinghouse and payer systems to ensure audit-ready documentation.
- US Billing Knowledge (MUST HAVE): Working knowledge of US medical billing/coding practices payer portals and the full claims life cycle from submission to adjudication/appeal.
- Coding Proficiency (MUST HAVE): Strong command of medical terminology modifier usage (e.g. 25 59 JW/JG when relevant) CPT and ICD-10 codingespecially as it impacts denials and edits.
- Portal Fluency: Confident navigating clearinghouses and payer portals (status checks reconsiderations appeals documentation uploads).
- Experience: Minimum of 2 years of hands-on experience in denial management medical billing claims management revenue cycle management or a similar payer receivables-focused role within a US-based healthcare setting.
- Appeals Writing: Ability to write concise payer-specific appeal narratives that cite clinical/coverage policy coding guidance and claim documentation.
- Analytical Mindset: Exceptional attention to detail; able to diagnose edits/denials and choose the right corrective path.
- Payer Expertise: Demonstrated understanding of the insurance payment and denial processes and proven experience in effectively appealing to payors.
- Communication Skills: Excellent professional phone presence with payers; clear written documentation in EMR/PMS and spreadsheets.
- Analytical Mindset: Exceptional attention to detail; able to diagnose edits/denials (e.g. CO-97 CO-18 bundling MUEs medical necessity) and choose the right corrective path.
- Basic Math: Confident verifying allowances adjustments and payment variances.
- Preferred Experience (Bonus only): Experience with claims related to Rheumatology is a significant advantage.
- Certification (Bonus only): A recognized Coding Certification is preferred but not required.
- Compensation: paid hourly.
- Schedule: 8 am to 5pm Eastern US time
- Structure: Remote offshore position.
Key Skills
- EMR Systems
- Clinical Laboratory Experience
- Athenahealth
- Algebra
- eClinicalWorks
- Primary Care Experience
- Phlebotomy
- Medical office experience
- Vital Signs Experience
- Experience Administering Injections
- Medical Terminology
- Medication Administration
About Company
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