JOB DESCRIPTION:
The INR Collections Subject Matter Expert (SME) serves as the primary escalation point and technical authority for insurance follow‑up and accounts receivable resolution. This role ensures timely resolution of unpaid, underpaid, and denied claims while supporting collectors through expert guidance, quality oversight, and adherence to payer rules, SLAs, and compliance standards.
Job Responsibilities:
- Handles complex, high‑balance, and escalated insurance accounts requiring advanced follow‑up and payer negotiation.
- Acts as the subject matter expert on payer rules, claim statuses, denial codes, and resolution strategies.
- Provides mentoring and real‑time guidance to INR Collectors on workflows, call handling, and documentation standards.
- Reviews and resolves payer denials, delays, and underpayments by identifying root causes and corrective actions.
- Supports appeal development by supplying documentation, coordination, and payer‑specific insight.
- Performs quality audits of INR collection work to ensure accuracy, compliance, and effectiveness.
- Identifies denial trends, payer issues, and AR aging risks; escalates systemic concerns to leadership.
- Supports development and maintenance of SOPs, job aids, and training materials.
- Ensures compliance with HIPAA and all confidentiality and regulatory requirements.
- Performs other related duties as assigned.
Minimum Requirements:
- Bachelor’s degree preferred.
- Minimum of 3 years of Revenue Cycle Management experience with strong focus on Insurance collections.
- Advanced knowledge of claim life cycle, insurance follow‑up, denial management, and payer escalation.
- Strong understanding of reimbursement principles
- Proficiency in RCM systems, AR work queues and Microsoft Office.
- Strong attention to detail, problem‑solving skills, and ability to manage high‑volume workloads.
- Excellent analytical, communication, and documentation skills.
Competencies:
- Commitment to Job Deliverables
- Trustworthiness and Ethics
- Attention to Communication
- Initiative
- Personal Credibility
- Interpersonal Skills
- Flexibility
- Thoroughness
- Self Confidence
Required Skills
COMMUNICATION
- Excellent professional verbal and written communication skills
- Ability to explain complex payer and denial issues clearly
- Strong documentation, note‑taking, and follow‑up skills
- Team‑oriented with mentoring capability
TECHNICAL SKILLS
- High attention to detail and analytical accuracy
- Strong Excel, Word, and Outlook proficiency
- Knowledge of payer portals, call documentation, and denial workflows
- Strong computer and RCM system proficiency
PHYSICAL ABILITIES
- Performs repetitive motion activities
- Sits for extended periods of time
- Requires close vision and frequent focus adjustment
- Ability to reach with hands and arms
WORK SCHEDULE
- Works at a standard workstation for extended periods
- Uses standard computer equipment including keyboard and monitor
- No lifting required for this position
- Must report to work on time and complete assigned shift
- Must be willing to work night shift as required by business needs
The base pay for this position is
N/A
In specific locations, the pay range may vary from the range posted.
JOB FAMILY:
Accounts Payable & Receivables, Credit & Collection, & Payroll
DIVISION:
HF Heart Failure
LOCATION:
Philippines > Taguig City : Five/Neo Building
ADDITIONAL LOCATIONS:
WORK SHIFT:
Standard
TRAVEL:
Not specified
MEDICAL SURVEILLANCE:
Not Applicable
SIGNIFICANT WORK ACTIVITIES:
Continuous sitting for prolonged periods (more than 2 consecutive hours in an 8 hour day)
