ISTA Solutions, an outsourcing/offshoring company, is in search of an experienced Medical Billing Team Lead 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 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…