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