Medical Claims Analyst

The Medical Claims Analyst is responsible for collections, account follow-up, billing, and allowance posting. The role ensures timely and accurate resolution of outstanding medical claims through proactive follow-up and strong analytical problem-solving.

Key Responsibilities

• Follow up with insurance payers via phone, email, fax, or portals.
• Meet and maintain daily productivity and quality metrics.
• Use workflow and client host systems to collect payments and resolve claims.
• Adhere to all client and team policies, procedures, and filing deadlines.
• Research payer-specific billing guidelines as needed.
• Analyze and resolve claim payment delays.
• Identify denial trends and communicate them to management.
• Initiate and process appeals with accurate supporting documentation.
• Correct medical billing errors.
• Understand underpayments, overpayments, and credit balance processes.
• Assist with special AR projects requiring strong analytical skills.
• Maintain professional communication with clients, patients, and internal teams.
• Handle PHI in accordance with HIPAA standards.
• Work independently using assigned work queues.
• Maintain confidentiality and professionalism at all times.
• Perform other duties as assigned.

Qualifications

• High School graduate
• Minimum 1 year of healthcare AR/collections experience in a BPO environment
• Experience in:
• Medical billing & AR collections
• Calling insurance payers for claim status
• Denials, appeals, and dispute resolution
• Strong understanding of healthcare claims and payer processes
• Willing to work onsite in Ortigas, Pasig
• Amenable to night shift