Offshore medical claims processors are integral to the healthcare industry, as they work with insurance providers to manage and process reimbursement claims submitted by patients and healthcare facilities. Their responsibilities are essential for ensuring accurate and timely reimbursements to healthcare providers and appropriate payments or deductions for patients based on their insurance coverage.
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Role of Offshore Medical Claims Processors
Offshore medical claims processors handle various administrative tasks and paperwork related to the processing of medical claims. Their role includes explaining the claims process to patients, addressing patient inquiries, and keeping patients informed about the status of their claims. When issues arise during claim processing, these processors collaborate with healthcare providers and patients to resolve problems and expedite payments whenever possible under the patient’s insurance coverage.
Tasks performed by medical claims processors encompass the following:
Reviewing patient data and medical records to verify the accuracy of claims.
Communicating with healthcare providers and patients in cases of claim delays.
Requesting missing information or seeking clarification on stalled claims.
Processing claims and ensuring the accuracy of payments.
Reviewing claims to confirm the delivery of services and reasonable charges.
Following up on stalled claims and facilitating payments if claims are approved.
Staying updated with medical coding standards such as CPT (Current Procedural Terminology) and ICD (International Classification of Diseases).
Skills and Qualifications
Many medical claims processors possess qualifications in fields such as Healthcare Information Management, Business Management, or Healthcare Administration. They often have clinical experience in healthcare settings and may have worked in roles related to medical records, data entry, and customer service, gaining expertise in CPT and ICD coding.
Key skills required by medical claims processors include:
Proficiency in medical terminology and coding.
Strong organizational skills, attention to detail, and the ability to meet deadlines.
Capability to maintain accurate records and uphold patient confidentiality.
Exceptional communication skills, both written and oral.
Competence in using relevant computer software and databases.
Strong analytical, problem-solving, and decision-making abilities.
Outsourcing to the Philippines
Kamel is the leading provider of offshore medical claims processors in the Philippines, offering comprehensive recruitment and onboarding services for your organization. With access to a vast network of highly experienced professionals, Kamel provides you with a shortlist of suitable candidates tailored to your requirements.
Your dedicated remote-based medical claims processors work full-time at Kamel’s state-of-the-art facility in Manila, where they have access to all the necessary resources and infrastructure to fulfill their roles within your organization. Kamel takes care of their HR needs, including payroll, holiday, and sick leave, as well as health insurance coverage. Additionally, all essential tools such as computers, software, high-speed internet access, and IT assistance are provided. Kamel handles the contractual and employer-related administrative tasks for your organization.
You can easily oversee and manage the work of your remote team members through phone, email, Skype, or Zoom.
For more information on hiring Offshore Medical Claims Processors in the Philippines for your business, please contact Kamel today.
