Medicare Claims Auditor

The leading BPO solutions provider in Leyte, Philippines, Virtual Staffing Solutions, offers a wide-ranging and comprehensive outsourcing solutions from call center services to back-office support, to highly complex data processing for SMEs and large corporations in the US and UK. 

Since its founding in 2018, the team has grown into a strong and competitive player in the BPO scene with over 1500+ employees and counting. Virtual Staffing has built its reputation of flexibility, quality, and industry excellence and has since brought its clients continual success in their business.

Responsibilities:

• Review patient medical bills, correspondence and Explanation of Benefits (EOBs) for accuracy
• Communicate with Insurance Companies and Providers to address any issues that are identified (e.g., appeal incorrectly denied claims, coordinate with providers to fix billing errors, negotiate with providers in the case of inappropriate billing)
• Communicate with clients via phone and email – respond to client requests in a timely and professional manner, go above and beyond to make sure concerns are addressed and medical bills and associated paperwork is no longer a worry
• Provide client support with benefit/health insurance questions
• Identify problems and inconsistencies by using management reports
• Summarize findings and make recommendations to resolve claims/billing issues
• Work on special projects for other divisions ie. EmployeeCare, Individuals, TotalCare

Skills and Requirements:

• A background in medical billing or insurance claims administration (Medical Billing, Coding and Collections Specialists, and/or Health Insurance Claims Administrators strongly preferred
• 3-5+ years’ experience in Medical Billing, Coding, A/R follow up and Collections experience preferred, including manual Out of Network (OON)
• Extensive Explanation of Benefits (EOB) knowledge
• Experience with Out of Network (OON) Benefits a plus
• Understanding of general Coordination of Benefit Rules, Benefit Analysis
• Knowledge of eligibility requirements and enrollment
• Experience in overturning claim denials - ranging from simple solutions such as coding correction to more complex, involving submission of appeals and grievances
• The desire to be part of a team of professionals that have fun while really making a difference to our clients
• Proficient with Microsoft Office
• Ability to think outside the box with excellent time-management skills and deadline management
• Problem solving skills that persist to a solution
• Excellent organizational and scheduling skills
• Ability to multi-task, while working with a sense of urgency
• Ability to prioritize many coexisting projects
• Self motivated / Self Starter
• Reliable
• Knowledge of CPT/ ICD- 9 and 10 is required. Medical Billing and / or Coding Certificate a plus
• Excellent communication and customer service skills – must be able to communicate effectively with Clients, Insurance Companies, and Providers both in writing and over the phone, including how to write appeal letters
• Website Navigation of carrier web portals to find info relative to resolution and/or claim processing
• Experience investigating and research for appeals and drug manufacturer websites for copay assistance
• Extensive phone experience with carriers and providers
• Strong interpersonal skills