Medical Claims Specialist
Pay Range: $17.54hr - $22.54hr
Requirement/Must Have:
- High school diploma.
- 3+ years of related work experience.
- Experience with medical billing and coding.
- Ability to prioritize handling of issues.
- Organization skills and ability to multitask.
- Strong verbal and written communication skills.
Responsibilities:
- Review medical claims and transmit to the insurance carrier using the practice electronic health records (EHR) system and clearing house.
- Monitor rejected claim reports and adjust claims for resubmission to the insurance carrier.
- Download insurance carrier explanation of payments (EOPs) to post claim payments and denials in the EHR system.
- Determine if denied claims can be corrected and re-submitted to the carrier.
- Review aging reports to research open balances and resubmit within insurance carrier filing limits.
- Utilize insurance carrier websites and contact carriers as needed to investigate denials and claim status.
- Partner with the clearing house to distribute patient billing statements and monitor the patient portal to post payments in the EHR system.
- Initiate overpayment refunds to patients and repayments to insurance carriers when required.
- Serve as the point of contact for the practice regarding all vision and medical claims.
- Support the corporate manager in maximizing claim collection rate.
- Monitor insurance carrier adjudication of medical claims for one or more doctor practices.
- Utilize a practice EHR system and clearing house to review and submit claims to multiple medical insurance carriers.
- Review open/unpaid claim balances and take required action.
Nice to Have:
- Experience working in multiple doctor practices.
- Experience working with multiple insurance carriers and an understanding of their claim requirements.
- Proven ability to identify issues and solve problems.
Skills:
- Medical Billing.
- Medical Coding.
- Electronic Health Records (EHR).
- Clearing House Operations.
- Claim Adjudication.
- Aging Reports.
- Insurance Carrier Portals.
Qualification And Education: