About this role
ISTA Solutions, an outsourcing/offshoring company, is in search of an experienced Medical Billing Specialist to join our rapidly expanding team. As a member of our team, you will have the opportunity to work with highly skilled professionals, who prioritize employee satisfaction and work-life balance. At ISTA Solutions, we pride ourselves on creating a culture focused on long-term success and life-long learning. We're looking for a team player who is ready to contribute to our mission, just like you!
Account specific roles & responsibilities:
SNF Billing
Process and submit claims for Skilled Nursing Facility (SNF) services.Bill Medicare Part A, Medicare Part B, Medicaid, Managed Care, HMO, and commercial insurance.Review patient census, admission, discharge, and payer information for billing accuracy.Verify patient eligibility, insurance coverage, authorizations, and benefit periods.Ensure compliance with Medicare SNF billing regulations and CMS guidelines.Monitor consolidated billing requirements and identify excluded services when applicable.
HMO Billing
Submit and manage HMO claims according to payer-specific requirements.Verify referrals, prior authorizations, and eligibility.Resolve HMO claim edits, rejections, and denials.Ensure timely filing and compliance with individual payer guidelines.Claims ProcessingPrepare, review, and submit clean claims electronically.Correct rejected claims and resubmit promptly.Monitor claim status through clearinghouses and payer portals.Maintain claim accuracy to maximize first-pass acceptance.Accounts Receivable (AR) ManagementPerform insurance follow-up on unpaid and underpaid claims.Research outstanding balances and payment discrepancies.Contact insurance companies regarding claim status and reimbursement.Escalate unresolved billing issues when necessary.
Payment Posting
Post insurance payments, contractual adjustments, patient payments, and denials accurately.Reconcile Electronic Remittance Advice (ERA) and Explanation of Benefits (EOB).Identify payment variances and investigate underpayments.Denial ManagementAnalyze denied claims to determine root causes.Prepare and submit corrected claims, appeals, and reconsiderations.Track appeal outcomes and maintain documentation.Compliance & DocumentationMaintain HIPAA compliance and patient confidentiality.Follow CMS, Medicare, Medicaid, and payer-specific billing regulations.Document all billing activities thoroughly within the billing system.Stay updated on changes to reimbursement policies and billing requirements.
Job Description:
Provides customer support through different communication channels (Phone, email, chat). Resolve issues & accommodate customer inquiries to ensure satisfaction with products or services. Collaborate with colleagues and different departments to resolve complex issues Maintain accurate records on customer interactions, transaction, feedback, etc. Requirements
Minimum 2 years of BPO U.S. Medical Billing experience.At least 1 year of dedicated SNF (Skilled Nursing Facility) billing experience.Experience billing HMO, Medicare, Medicaid, Managed Care, and Commercial Insurance.Strong knowledge of:Medicare Part AMedicare Part BMedicaidSkilled Nursing Facility reimbursementManaged Care plansCoordination of Benefits (COB)Accounts Receivable follow-upDenial ManagementAppeals ProcessElectronic Claims SubmissionExcellent verbal and written English skillsWilling to work onsite in Buendia, MakatiAmenable working night shiftBenefits
What can we offer you?
Competitive salary and benefits Health Insurance with free dependents* 10%-night differential Attendance Bonus Paid time off Convertible to cash leave credits Performance Appraisal Work-life balance A focus on growing your career path with us We encourage you to follow your passions and learn new skills Our commitment to you
Strong culture and values-driven leadership We create opportunities for you to learn and grow at any stage of your career Continuous learning and innovation We foster an all inclusive environment where everyone thrives