Subject Matter Expert - INR Collections

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:

• Fostering Teamwork

• Analytical Thinking

• Commitment to Job Deliverables

• Leadership

• Decision making

• Trustworthiness and Ethics

• Attention to Details

• Problem Solving

• Attention to Communication

• Technical Expertise

• Customer Orientation

• Analytical Thinking

• Managing Change

• Adaptability

• Managing Performance

• Stress Management

• 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)