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 Processing
- Prepare, 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) Management
- Perform 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 Management
- Analyze denied claims to determine root causes.
- Prepare and submit corrected claims, appeals, and reconsiderations.
- Track appeal outcomes and maintain documentation.
- Compliance & Documentation
- Maintain 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.
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 A
-
Medicare Part B
-
Medicaid
-
Skilled Nursing Facility reimbursement
-
Managed Care plans
-
Coordination of Benefits (COB)
-
Accounts Receivable follow-up
-
Denial Management
-
Appeals Process
-
Electronic Claims Submission
-
Excellent verbal and written English skills
-
Willing to work onsite in Buendia, Makati
-
Amenable working night shift
Benefits
-
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