Medical Claims & Account Specialist (RCM Healthcare)

We're Hiring: Medical Claims & Account Specialist (RCM Healthcare)!

The Account Specialist plays a critical role in supporting a designated caseload of home care providers to ensure timely, accurate decisions regarding third-party billing. In this role, you will act as a trusted partner to customers through troubleshooting issues, resolving billing concerns, and proactively monitoring account health to prevent disruptions. You will leverage analytical tools, collaborate across teams, and maintain clear communication to drive positive outcomes and an exceptional customer experience. This position reports to the Manager of Account Management.

Location: Ortigas Center, Philippines
Work Mode: Flexible office & remote (Hybrid)
Role: Medical Claims & Account Specialist (RCM Healthcare)

What You'll Do:
• Process claims in accordance with payer regulations, medical authorizations, protocols, and departmental guidelines
• Investigate and resolve claim denials and rejections using payer resources, clearinghouse tools, and internal documentation
• Identify, research, and analyze trends in submitted claims to develop actionable resolutions
• Provide timely and professional support via email using a ticketing system to resolve customer inquiries
• Assist customers with setup and navigation of billing platforms, software tools, or other program features as needed
• Maintain consistent and proactive communication to ensure customers feel informed and
supported
• Monitor overall account health, including authorization expirations, clearinghouse rejections, aging reports, and payer trends
• Utilize Power BI and other reporting tools to analyze data, uncover discrepancies, and build action plans for issue resolution
• Document all updates and interactions thoroughly within the CRM to ensure continuity and reduce repeat inquiries

What We're Looking For:
• Minimum 2 years of experience in end-to-end revenue cycle management (RCM), healthcare billing, or related functions with emphasis on third-party payer claims
• Proficiency with CRM systems (HubSpot preferred) and billing software
• Strong written and verbal communication skills with professional business etiquette
• Excellent time management, organization, and follow-up skills
• Demonstrated problem solving and decision-making abilities
• Experience with project management or leading process improvements
• Familiarity with analytical tools such as Power BI or similar reporting platforms
• Proficiency with Microsoft Office Suite (Outlook, Word, Excel)

Eager to make a difference in healthcare Apply now and be part of our growing team!

#revenuecyclemanagement #billing #claimsprocess #endtoendclaims #fullcyclebilling #epic #emr #availity #medicaid #veteransaffair #startasap