Jade Solutions and Management Services, Inc. Claims Processor

₱15-20K[Monthly]

On-site - MakatiFull-time1-3 Yrs ExpBachelor

Claims Processing

Review and analyze healthcare claims for accuracy, completeness, and adherence to contractual agreements and regulatory guidelines.
Verify member eligibility and benefits coverage for submitted claims.
Evaluate medical documentation to assess the appropriateness of services rendered and coding accuracy.
Adjudicate claims accurately and efficiently within established turnaround times.
Identify and investigate potential fraudulent or abusive billing practices.
Communicate claim decisions, payment details, and denials to providers and members effectively.
Collaborate with other departments, such as Provider Relations and Customer Service, to resolve claim-related issues and inquiries.
Maintain comprehensive and organized claim records, documentation.

Educational Qualifications: Minimum Bachelor's degree in a related field such as healthcare administration or management.
Experience Level: Seeking candidates with 1-3 years of experience in a healthcare setting, particularly with claims processing and assistants' roles.
Skills and Competencies: Proficiency in medical billing and coding, insurance regulations, and healthcare claims processing software.
Responsibilities and Duties: Assisting healthcare providers in submitting accurate claims, following up on unpaid claims, ensuring compliance with insurance guidelines.
Working Conditions: The candidate will work in a fast-paced medical office or hospital environment and must be able to multitask efficiently.
Qualities and Traits: Attention to detail, excellent communication skills, and a strong commitment to patient privacy and ethics in healthcare.