Medical Claims Consultant jobs

We are looking for an experienced US Healthcare AR Follow-Up Specialist who can manage outstanding insurance claims, investigate denied or underpaid claims, and work directly with insurance payers to help ensure timely reimbursement.

You will primarily handle US medical billing accounts receivable, claim follow-ups, denial resolution, and payer communication. This role is ideal for someone who understands the US healthcare revenue cycle and is comfortable working independently while managing multiple claims accurately.

We are looking for the following specific requirements

• Bachelor's degree or equivalent experience.
• 1 to 3 years of experience in US Healthcare Accounts Receivable, Medical Billing, or Revenue Cycle Management.
• Hands-on experience with insurance claim follow-up and denial management.
• Experience working with Medicare and commercial insurance payers.
• Good understanding of the US medical billing and revenue cycle process.
• Familiarity with CPT, ICD-10, HCPCS, modifiers, LCD/NCD, and CCI edits.
• Experience investigating unpaid and underpaid claims.
• Experience submitting corrected claims and appeals.
• Strong written and verbal communication skills.
• Good analytical and problem-solving skills.
• Strong attention to detail and ability to manage multiple claims accurately.

Your responsibilities will include (but are not limited to):

• Follow up on outstanding insurance claims with Medicare and commercial insurance payers.
• Use payer portals, IVR systems, and insurance representatives to check claim status and resolve issues.
• Track and manage claim follow-ups using the company's systems.
• Investigate unpaid, underpaid, rejected, and denied claims.
• Identify the reason for claim denials and determine the appropriate next action.
• Submit corrected claims, reconsiderations, or appeals when necessary.
• Work with Billing, Coding, and Operations teams to resolve claim issues.
• Maintain accurate notes and documentation for all claim follow-ups.
• Help ensure reimbursements are received within expected timelines.
• Identify recurring denial issues and flag potential process improvements.
• Meet productivity and quality expectations while maintaining accuracy.

This Position Is Perfect For You If You Are…

• Detail-oriented and highly organized.
• Comfortable investigating claims and figuring out why they were not paid correctly.
• Analytical and solution-focused.
• Proactive and good at following through on outstanding issues.
• Comfortable communicating with insurance representatives.
• Able to manage a high volume of claims without sacrificing accuracy.
• Dependable and accountable for your work.
• Comfortable working independently.
• Collaborative and able to work with different teams.
• Adaptable and willing to learn new systems and processes.

Pay: From Php70,000.00 per month

Benefits:

• Additional leave
• Company Christmas gift
• Company events
• Health insurance
• Paid training
• Work from home

Application Question(s):

• Years of experience working as a Freelancer or as a Virtual Assistant (DO NOT include any time spent working from home due to the pandemic if your role was originally office-based.)
• Are you comfortable using Hubstaff for time tracking? It’s required for all our VAs—just screenshots, no videos.
• Do you have a main and backup computer? This is strictly required as we conduct system checks.
• Do you have a main and backup internet? This is strictly required as we conduct system checks.

Experience:

• US Healthcare Accounts Receivable (AR): 2 years (Preferred)
• US Medical Billing and Revenue Cycle Management (RCM): 2 years (Preferred)
• Medicare and commercial insurance payer: 2 years (Preferred)

Work Location: Remote