Job Description

As a Claims Specialist , you are the engine behind our financial health. You’ll be navigating the complexities of the healthcare reimbursement cycle to ensure accuracy, transparency, and efficiency. You will act as a vital bridge between our clinics and insurance payers, ensuring that the care our patients receive is reflected accurately in our billing. This role is based in Flower Mound, TX and will work very closely with multiple departments to ensure strong communication among the various stakeholders.

JOB SPECIFIC FUNCTIONS:

• Revenue Lifecycle Management: Manage the end-to-end claims process, including claim submission, adjudication, payment posting, and patient account reconciliation.

• Claim Integrity: Meticulously verify visit details—including time, location, and insurance authorization—to minimize denials before they happen.

• Strategic Payer Follow-up: Proactively track remits and engage with insurance payers to resolve outstanding issues and ensure timely reimbursement.

• **Medical Records & Documentation Support: **Manage and submit medical records to insurance companies and authorized third parties in a timely manner to fulfill documentation requests.

• Cross-Functional Collaboration: Collaborate with internal teams to coordinate patient insurance updates, manage claim hold protocols, and support resolution of claim-related issues.

• **Compliance & Accuracy: **Ensure all claims utilize correct billing information (providers, modifiers, and clinic locations)

• Queue Management: Effectively prioritize and manage assigned responsibilities within revenue cycle operations while maintaining accuracy and efficiency.

• Quality Control: Audit claims for appropriate modifiers and correct billing data points prior to transmission.

Qualifications

• Education: High School Diploma required; Bachelor's Degree in progress or completed preferred.

• Experience: 2 years of Medical Billing/RCM experience (preferred).

• Skills:

* Deep understanding of medical billing/coding and EMR systems.

* Proficiency in office technology and multi-line phone management.

* Exceptional organizational skills with high attention to detail.

* Strong interpersonal skills for effective team and patient communication.