Job Description
Optum is hiring an AR Follow-Up/Medical Claims Collections Specialist to join our provider-side revenue cycle team in Metro Manila. You will manage accounts receivable for medical claims, focusing on follow-up with payers and providers, addressing unpaid claims, denials, and reconciliation to improve cash flow and provider satisfaction.
As part of our dynamic healthcare operations, you will be responsible for proactive claim follow-up, denial management, and accurate billing reconciliation. You will use payer portals and internal systems to track claim status, contact insurance payers and medical providers, and document all actions to ensure timely resolution while maintaining data privacy and regulatory compliance.
We value accuracy, collaboration, and a customer-focused mindset. This role offers opportunities to grow within a global health services leader, exposure to diverse payer environments, and competitive compensation in a fast-paced setting. If you thrive in a structured process, possess strong communication skills, and are detail-oriented, you will fit right in with Optum's mission to help people live healthier lives.
Join us in Manila and contribute to streamlined revenue cycle workflows that support clinicians and patients alike.
Responsibilities
- Manage end-to-end AR follow-up for medical claims from submission to resolution, focusing on maximizing paid claims and reducing aging AR
- Initiate and respond to communications with payers and healthcare providers to obtain claim status updates and resolve discrepancies
- Identify and appeal denials, implement corrective actions, and monitor overturn rates
- Perform thorough billing reconciliations and ensure accurate patient and claim data
- Monitor AR aging reports, track KPIs, and escalate blockers to the appropriate teams
- Maintain strict adherence to privacy and regulatory requirements while handling sensitive medical information
- Collaborate with internal departments to resolve claim-related issues and improve end-to-end revenue cycle processes
- Document activities and maintain detailed logs for compliance and audit readiness
Qualifications
- Bachelor's degree or equivalent experience in healthcare administration, finance, or related field
- 2+ years of experience in AR follow-up, medical claims collections, or healthcare reimbursement
- Experience with payer portals (e.g., government and private payers) and claims processing systems
- Strong analytical and problem-solving skills; detail-oriented with a high level of accuracy
- Excellent written and verbal communication; ability to negotiate and resolve conflicts professionally
- Proficiency in Microsoft Excel and data entry; working knowledge of revenue cycle metrics and KPIs
- Knowledge of medical billing, coding, and HIPAA-like privacy concepts; commitment to confidentiality
- Ability to work in a fast-paced, target-driven environment and collaborate with cross-functional teams