Senior Medical Billing Specialist | US HMO | 21K Signing Bonus

ISTA Solutions, an outsourcing/offshoring company, is in search of an experienced Senior 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: Team Lead - Oversee the end-to-end medical billing process, including claim submission, denial management, follow-ups, and cash posting. - Lead, supervise, and provide guidance and coaching to the medical billing team. - Monitor team productivity, billing accuracy, and performance against established targets. 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 6 months of team lead / supervisory / SME / Senior 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 Shaw Blvd, Mandaluyong - 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