Job description
Join Optum, a global leader in health services, as a Medical AR Claims Specialist focused on AR follow-up and provider-side revenue cycle management in Metro Manila. This role drives value by optimizing cash flow, reducing days in accounts receivable, and resolving complex claim issues across the patient, provider, and payer spectrum. You will collaborate with healthcare providers to ensure accurate submissions, timely reimbursements, and compliant revenue-cycle processes. This position offers meaningful work in a fast-paced environment where attention to detail, proactive problem-solving, and clear communication translate into measurable financial improvements for healthcare organizations.
In this provider-side capacity, you’ll manage unpaid claims, denials, and AR reconciliations, while adhering to HIPAA and data privacy standards. You’ll gain exposure to payer guidelines, coding accuracy (CPT/HCPCS, ICD-10), and end-to-end claims lifecycle. If you are energized by data-driven decision-making and want to contribute to better patient access to care through efficient revenue cycle operations, this role is for you.
What you’ll do at Optum: support provider AR follow-up and collections; investigate and resolve claim denials; perform billing reconciliations; ensure coding accuracy and contract compliance; communicate with providers, payers, and internal teams; monitor AR metrics and prepare action plans for improvement. We value collaboration, continuous learning, and a commitment to quality and privacy in every interaction.
Responsibility
- Follow up on outstanding medical claims and patient accounts to maximize recoveries and reduce AR days.
- Analyze denials and rejections; identify root causes and collaborate with providers and payers to secure timely payment.
- Coordinate with healthcare providers to correct claim discrepancies, ensuring accurate CPT/HCPCS and ICD-10 coding on submissions.
- Perform billing reconciliation and verify contract compliance to ensure precise revenue capture.
- Communicate with providers, payers, and internal teams to resolve escalated AR issues and payment discrepancies.
- Document audit-ready notes and resolutions for each claim in the AR workflow and maintain complete claim histories.
- Monitor key AR metrics (Aging, Denial Rate, cash collections) and generate regular performance reports for management.
- Ensure adherence to HIPAA and data privacy standards while handling sensitive patient information.
Qualification
- Bachelor’s degree in Healthcare Administration, Finance, or a related field (or equivalent practical experience).
- Proven experience in medical AR follow-up, claims processing, and denial management.
- Strong knowledge of medical billing, CPT/HCPCS, ICD-10 coding, and payer guidelines.
- Experience with AR software, claims processing systems, and data entry accuracy; proficiency in Excel or data tools.
- Excellent communication skills with the ability to interact professionally with providers, payers, and internal teams.
- Detail-oriented, analytical mindset with strong problem-solving abilities and the ability to meet deadlines.
- Ability to multitask, prioritize workload, and work effectively in an on-site or hybrid environment.
- Commitment to HIPAA compliance and high ethical standards in all interactions.