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.
- 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
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