Medical Claims Specialist

View full description

Requirements:

• High school diploma or GED equivalent required
• 1+ years of medical facility or medical office billing experience
• Previous experience with an electronic medical/health record system
• Knowledge of insurance collections processes
• Demonstrated ability to research comprehensive collection issues
• Able to successfully collaborate within team projects
• Strong attention to detail
• Understanding of associated privacy legislation related to healthcare information, i.e., HIPAA
• Demonstrates awareness, inclusivity, sensitivity, humility, and experience in working with individuals from diverse ethnic backgrounds, socioeconomic statuses, sexual orientations, gender identities, and other various aspects of culture

Responsibilities:

• Contact carriers regarding denied claims
• Submit Appeals to payors as needed to ensure reimbursement for denied claims
• Timely resubmissions of corrected claims when needed
• Follow up on claims pending responses from carriers in excess of their standard processing time
• Follow established policies and procedures to safeguard collection
• Collaborate with Internal Departments to ensure accuracy of claims processing
• Report any trends in denied claims to Supervisors
• Support leadership with daily, weekly monthly reporting needs as required
• Other duties and/or special projects as needed