Patient Account Specialists play a crucial role in ensuring an efficient RCM process at both the claim and patient levels. They manage patient accounts from Eligibility to charge submission all the way through tofinal resolution, working collaboratively to ensure the successful collection of all outstanding accounts receivable. This includes timely payment posting and successful appeals to expedite reimbursement.

• Health Insurance/HMO
• Enjoy unlimited MadMax Coffee
• Diverse learning & growth opportunities
• Accessible Cloud HR platform (Sprout)
• Above standard leaves

• Scrub and submit daily charges to various payers.
• Complete daily eligibility and benefit verification for all facilities utilizing best practice processes
• Document financial and pre-certification information according to defined process in a timely manner.
• Maintain and update patient demographic information and insurance details within the billing system.
• Communicate with the front-end staff regarding patient deductibles, copays, and scheduling, ensuring accurate billing information is captured and communicated.
• Locate remittances and payments in various portals.
• Read and interpret Explanation of Benefits (EOBs).
• Post payments manually or electronically (ERA), including patient and insurance payments, adjustments, and denials.
• Transfer copay, coinsurance, and deductible balances to patient responsibility.
• Review patient account balances to ensure posting accuracy as needed.
• Perform payment and bank reconciliations.
• Conduct daily cash reconciliation and reporting.
• Research and resolve unapplied accounts.
• Review EOBs to ensure appropriate steps are taken in resolving accounts; investigate, follow up with payers, and take appropriate action on insurance and legacy accounts assigned.
• Ensure proper claim submission and payment through review and correction of claim edits, errors, and denials.
• Solve practical problems and deal with various concrete variables in situations with limited information.
• Effectively communicate via the CRM ticketing system with clients and internal staff members.
• Submit requests to clients for medical records as needed.
• Stay informed about current department policies and procedures.
• Meet or exceed quality and quantity benchmark targets established by management (e.g., productivity, AR days, cash collections, bad debt, past-due follow-up).
• Ensure the confidentiality of all patient accounts by following HIPAA guidelines.
• Respond timely and accurately to all incoming correspondence and inquiries from insurance companies and other appropriate parties.
• Post payments manually or electronically (ERA), including patient and insurance payments, adjustments, and denials.
• Locate remittances and payments in various portals.
• Transfer copay, coinsurance, and deductible balances to patient responsibility.
• Review patient account balances to ensure posting accuracy as needed.
• Perform payment and bank reconciliations
• Conduct daily cash reconciliation and reporting.
• Research and resolve unapplied accounts.

• High school diploma or equivalent; college degree preferred.
• Recent experience in vision care claim processing or a similar role in healthcare insurance is highly desirable.
• Experience in Insurance Verification & Eligibility
• Strong and current knowledge of vision care insurance policies, procedures, and clearinghouses.
• Ability to do medical coding in ICD-10, CPT, HCPCS, and modifiers for professional fees.
• Excellent organizational and time-management skills.
• Exceptional communication and customer service skills.
• Proficiency in using claim processing software and Microsoft Office Suite.
• Attention to detail and ability to multitask effectively.
• Ability to work independently and as part of a team.
• Adheres to internal and system-wide competencies, behaviors, policies, and procedures to ensure efficient work processes

• Scanned copy of valid NBI Clearance
• Accomplished Medical or PEME Slip (covered by KMC)
• 2x2 & Half body picture with white background
• Proof of government numbers (TIN, SSS, Pag-ibig, & Philhealth)
• Photocopy of 2 valid IDs – front & back (government-issued)
• Clear copy of your Birth Certificate (PSA or NSO)
• Accomplished HR Forms & Promissory Note (will be provided by KMC’s Onboarding Team

If you're a rockstar at what you do and looking to be a part of our amazing story, we want to hear from you!

We offer attractive salaries and benefits plus you get to work in some of the Philippines' best flexible workspaces. Our employees also get to enjoy exclusive discounts, rewards and freebies, and invites to our monthly events. We are always recruiting for roles in IT & Development, Marketing, Business Administration, HR & Recruitment and Legal & Finance Roles.

KMC provides quality employment opportunities for job-seekers looking for a career that is both challenging and fulfilling. We are also committed to providing equal opportunities at every selection stage. We do not discriminate due to age, gender, sexual orientation, ethnicity, nationality, and religion.

KMC Solutions offers a variety of career opportunities in Metro Manila, Cebu and Clark & Iloilo. We are always looking for talented and enthusiastic individuals who are ready to make their next big career move.

At KMC, we foster an inclusive and positive workplace for all. We push our members to succeed in everything they do through our collaborative work environment. We encourage our community to work hard and reach their full potential while delivering results that matter for our members and you as professionals.

We host amazing and quality events and implement people-centric policies to work flexibly. We ensure that everyone in our expansive network is engaged, from our internal employees and those who work on behalf our offshore partners.

At KMC, we work hard and we are committed to putting our best foot forward in everything we do. Everyone is encouraged to be an individual while also working for the collective good of the KMC Community. We believe mistakes are opportunities and that you should not present a solution without a problem.

We also know when hard work deserves to be recognized so we reward our employees with monthly parties, free trips and much much more!