Job Description

MEDICAL CLAIMS SPECIALIST

The CLAIMS SPECIALIST is responsible for providing expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing, and adjusting claims.

Knowledge of medical billing and coding is required. Critical and analytical thinking is vital. Must be able to work independently and in a team environment, take the initiative and be willing to learn all aspects of the medical billing revenue cycle and other aspects of the company.

REQUIREMENTS:

• Knowledge of HIPAA compliance, UB04 and CMS1500 claim forms, ICD-9, ICD-10, or CPT codes, is preferred but not required.
• Superior knowledge of Microsoft Office (Word and Excel)
• Working Knowledge of QuickBooks or other commercial accounting software
• Excellent written and verbal communication skills
• Ability to communicate professionally during interaction with colleagues, clients, patients, as well as the private health insurance representatives
• Minimum of an associate degree or equivalent experience in the field

RESPONSIBILITIES:

• Reviewing explanation of benefits and correspondence
• Read Code diagnoses, procedures, complications, and co-morbidities for inpatients and out-patients accurately
• Provide general claims support by reviewing, researching, investigating, processing, and adjusting claims
• Assures that the proper documentation is available for claims to be processed
• Conduct data entry and re-work
• Demonstrates expertise in the use of automated systems and any other that may pertain to coding.
• Analyze and identify trends and provide reports as necessary
• Consistently meet established productivity, schedule adherence, and quality standards
• Recognize claims by determining claim type - HCFA, Hospital, Dental, and RX
• Identify more complicated claims and work with team members to adjudicate
• Flag and note potential reoccurring or long-term care claims
• Calculate other insurance and re-pricing benefits
• Work claims files to ensure the appropriate eligibility and provider records are matched to the claim.
• Updates and maintains claims tracking database
• Take Physician and Facility calls related to claims and provide exceptional customer support.
• Interacts positively, friendly, and professionally with physicians, patients/family, office staff, hospital staff, medically supply and drug company representatives, insurance companies, attorneys, worker’s compensation adjusters, and others.
• Compose responses to claims appeals and review medical records related to claims
• Payment posting and accounts payable
• Speaks clearly, concisely, and with consideration and respect in a group or one-on-one; articulates thoughts well and has a good rapport with listeners. Communication is clear, concise, and understandable. Presentation is always polite, considerate, and patient.
• Additional duties as assigned

 BENEFITS

We strive to offer an environment that provides our employees with the right balance between work and personal life. We offer a comprehensive benefits package including:

Base Salary

Health Insurance (Benefit after 60 days for the employee)

Paid vacation, personal days, and holidays

Positive, friendly, and helpful atmosphere

COVID VACCINE NOT REQUIRED

JOB TYPE: Full-time

REQUIRED EDUCATION

Minimum of Associate Degree (or comparable experience)

PAY: 34k to 40k Annually (Guaranteed Raises Annually)