Offer summary

Qualifications:

Bachelor's Degree in Nursing, Medical Science, or related healthcare field., 1-2 years of experience in handling insurances and appeals processing., Knowledge of medical terminologies and billing guidelines., Excellent communication and organizational skills with attention to detail..

Key responsibilities:

Process insurance audit requests and appeals, ensuring proper documentation.

Review and compile medical records and documentation for audits.

Communicate with auditing agencies and follow up on additional documentation.

Prepare and submit responses to various departments regarding compliance and medical review.

Job description

Discover your 100% YOU with MicroSourcing!

Position: Insurance Admin Assistant

Location: Two E-Com, MOA, Pasay City

Work Set-up & Shift: Work From Home & Night Shift

Position Summary

An Insurance Admin Assistant is responsible for processing insurance audit requests and appeals processing, post service review of patient’s medical records and customer care team member’s transactions to ensure proper processing of orders. This role is also involved in preparing, drafting

and submitting responses to various departments or auditing agencies on matters of compliance and medical review.

Your Role

Insurance Audit Request Processing
Handles correspondence pertaining to requests of medical documentation from all insurance, government, and commercial auditing agencies.
Logs audit request on a spreadsheet in the shared folder
Reviews billing history and notes of the audited equipment or accessories in HDMS (Billing Software)
Pulls all requested medical documentation (Rx/Certificate of Medical Necessity (CMN), Chart Notes, Lab Results, Proof of Delivery, etc.) from DocFlow (Document Management Software).
Reviews medical documentation and identify missing elements per insurance requirements
Requests and follow up additional documentation or missing elements from doctor’s offices, hospitals, SuperCare’s customer care, medical necessity, and/or accounts receivable teams.
Communicates to auditing agencies if clarification or additional information is required.
Creates cover letter with summary of patient’s qualifying medical condition
Compiles all medical documentation into one PDF file format
Submits medical documentation to auditing agencies via fax or insurance portals.
Insurance Appeals Processing
Handles all correspondence pertaining to audit decisions from insurance, government, and commercial auditing agencies
Requests and follow up additional documentation or missing elements identified during audit from doctor’s offices, hospitals, SuperCare’s customer care, medical necessity and/or accounts receivable teams
Creates cover letter & compiles all medical documentation for all levels of appeal into one PDF file format
Communicates decision to accounts receivable team on whether to continue to bill or pick up the equipment.

Qualifications

Bachelor's Degree in Nursing, Medical Science or any other medical/healthcare field.
At least 1-2 years of experience/background knowledge in handling insurances, appeals processing and reviewing/auditing medical records.
Preferably with general knowledge of medical terminologies and Medicare or commercial insurance general billing guidelines.
Ability to review/understand patient medical records and determine morbidities, limitations and needs.
Excellent Communication Skills (both written and verbal)
Strong organizational skills with high level of accuracy and attention to detail.
Proficient in using MS Office (Word, Excel etc.), PDF Editors and Google Suite.
Amenable to work on Night Shift.
Amenable to Work From Home until further notice.

Required profile