Job Description

We are seeking a detail-oriented Medical Billing Specialist based in Manila to support US-based home health agencies. The ideal candidate will have hands-on experience in processing claims under Medicare, Medicaid, and commercial payers with a strong grasp of PDGM, OASIS, and HIPPS codes. This role is crucial to ensuring timely and accurate revenue cycle performance in accordance with US home health billing standards.

Key Responsibilities:

• Review and validate clinical and administrative documentation (e.g., OASIS, Plan of Care, Face-to-Face documentation) before billing.

• Accurately generate and submit RAPs, Final Claims, NOAs (Notice of Admission), and NOEs (Notice of Election) through Medicare DDE, clearinghouses, or EHR systems (e.g., Kinnser, WellSky, Axxess, HCHB).

• Assign appropriate HIPPS codes and billing modifiers based on clinical inputs and assessments.

• Track and follow up on unpaid or denied claims; initiate appeals and resubmissions as necessary.

• Maintain AR follow-up and timely posting of payments, adjustments, and write-offs.

• Communicate proactively with US-based teams (Billing, Clinical, QA) to resolve claim issues.

• Stay current with CMS and payer-specific updates impacting home health billing.

• Ensure all processes comply with HIPAA and data security standards.

Qualifications:

Education: College graduate (with preference for medical or business-related courses).

Experience: Minimum 1 year of experience in US home health billing.

Technical Skills:

• Familiar with Medicare billing guidelines and the PDGM model.

• Proficient in home health EMRs (e.g., WellSky, Kinnser, Axxess, HCHB).

• Experience using DDE/FISS and/or medical billing clearinghouses.

• Working knowledge of HIPPS codes, CPT/HCPCS, and ICD-10.

Soft Skills:

• Excellent English communication skills (written and spoken).

• High attention to detail and organizational skills.

• Ability to work US business hours (Eastern or Central time zones).

Preferred Qualifications:

• Prior BPO/RPO experience in US healthcare or RCM support.

• Knowledge of U.S. insurance authorization and eligibility workflows.

• Certification in medical billing (e.g., AAPC CPB, AMBA CMRS) is a plus.

Work Setup:

• Schedule: Mixed; Day Shift & Night shift aligned with US time zones (EST/CST preferred).

• Work Location: 100% Work-in-Office

Tools Provided: HIPAA-compliant equipment and secure internet access required