Medical Billing Specialist

Sysgen RPO is hiring Medical Billing Specialist for direct hire with client

About the job:

• Direct hire, Full-time
• Work on -site in Ortigas, Pasig City
• Required skills and experience: clinical background and work experience in billing

Summary: The Revenue Cycle Denials Specialist is responsible for identifying, investigating, appealing, and resolving denied or underpaid healthcare claims to maximize reimbursement and minimize revenue leakage. This role works closely with payers, providers, coding teams, clinical staff, and billing departments to ensure timely resolution of denied claims while maintaining compliance with payer and regulatory requirements.

Key Responsibilities:

• Review and analyze denied, rejected, and underpaid claims to determine root causes.

• Research payer policies, contracts, and reimbursement guidelines to support appeals and claim resolution.

• Prioritize denial inventory based on financial impact and timely filing requirements.

• Identify trends and recurring denial patterns and recommend corrective actions.

• Prepare and submit high-quality first-level, second-level, and administrative appeals.

• Draft appeal letters supported by clinical documentation, coding guidelines, and payer policies.

• Follow up with insurance carriers to ensure timely review and adjudication of appealed claims

• Maximize reimbursement through effective claim correction, reconsideration requests, and appeals.

• Monitor aging denial accounts and ensure timely resolution.

• Track recovered revenue and maintain performance metrics.

Qualifications

• College graduate or equivalent (Bachelor's degree preferred)

• Minimum 2 years of experience in healthcare revenue cycle management specifically denial management (denied claims inventory/collection)

• Understanding of ICD-10-CM, CPT, HCPCS, and medical necessity guidelines.

• Experience with electronic health records (EHR) and billing systems.

• Certified Professional Biller (CPB), Certified Revenue Cycle Representative (CRCR), or similar certification is a plus.

• Experience in hospital, physician practice, or healthcare outsourcing/BPO environments is preferred.

• Technical appeal writing experience preferred.

• Familiarity with payer portals and denial management software.

• Proficiency in Microsoft Excel, Word, and revenue cycle applications.

• Knowledge of healthcare reimbursement methodologies.