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Job Description Looking to take your career to the next level? Then this role is for you! Join Outsourcey and be part of our mission to revolutionize global talent expansion! We connect businesses with dedicated full-time teams in the Philippines, offering cost-efficient solutions without compromising quality. Join us and help elevate businesses with complete control and comprehensive support, let's shape the future of work together! Profile Requirements: Experience: Background in medical billing or healthcare administration supporting claims, insurance workflows, and provider operations. Behavioral Health Billing Exposure: Experience with mental health and substance use billing is strongly preferred, including common payer requirements and documentation sensitivities. Coding & Terminology: Working knowledge of CPT, healthcare medical terminology, and medical records concepts, with attention to accuracy in claim creation and edits. Insurance Workflows Mastery: Proven capability with insurance verification, eligibility checks, claim submissions, claim status follow-up, denials management, and prior authorization processes. Systems & Documentation: Comfortable working inside an EMR; experience with Kipu is a plus, with strong documentation habits and clean internal notes for billing traceability. Reliability & Detail Orientation: Highly organized, reliable, and detail-oriented with the ability to manage multiple open claims and requests while maintaining quality and patient-centered professionalism. Core responsibilities: Claims Submission & Follow-Up: Prepare, scrub, submit, and track behavioral health and substance use claims; follow up proactively on rejections, denials, and underpayments through payer portals and calls. Claim Status Updates & Resolution: Provide clear claim status updates to internal stakeholders; research issues, correct errors, and resubmit or appeal as needed to keep A/R moving. Insurance Verification & Benefits: Verify eligibility and benefits for mental health and SUD services, confirm coverage details, and document payer requirements prior to service. Prior Authorizations Coordination: Initiate, obtain, and track prior authorizations; coordinate required clinical/ administrative details with facilities and payer reps to prevent claim delays. Facility, Payer, & Client Communication: Coordinate and communicate with facilities and payers; speak with clients regarding insurance questions and what is needed to support billing and reimbursement. Billing Support & Admin: Use Kipu EMR to manage patient billing workflows, documentation touchpoints, and records support; complete related admin work as a medical virtual assistant to keep provider operations organized. Benefits: Competitive salary Opportunity to shape the HR function of a rapidly growing BPO. Work closely with a team of industry leaders who have successfully scaled BPOs in the past. Career growth and development opportunities. Please attach your CV and we will be in touch for a confidential chat. Let's do great things together! This is a remote position.
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