Overview
We are seeking a detail-oriented and highly skilled Claim Specialist/Coder to join our busy Ophthalmology Surgery Center. The ideal candidate will possess a comprehensive understanding of medical coding, billing, and claims processing, ensuring accurate and efficient submission of insurance claims and processing claim denials and appeals. The Claim Specialist/Coder will play a vital role in optimizing revenue cycle operations while maintaining compliance with industry standards and regulations. Hours are Monday through Friday 8:00am to 4:30pm.
Responsibilities
- Resolve claim denials or rejections and implementing corrective actions with the proper appeals.
- Collaborate with medical biller to ensure proper documentation supports coding decisions and accuracy.
- Occasional billing of charges.
- Stay current with updates to coding guidelines, payer policies, and regulatory changes affecting medical billing practices.
- Maintain detailed records of claim submissions, adjustments, and follow-up with medical records requests.
- Must be able to multitask and work in a team environment.
Qualifications
- Three years minimum experience
- Proven experience in medical coding, billing, or claims processing within a healthcare setting.
- Excellent attention to detail with the ability to interpret clinical information accurately.
- Effective communication skills for collaborating with healthcare providers, insurance companies, and internal teams.
- Extensive knowledge of insurance-related policies
- Knowledge of Medicare rules, local and national coverage determination.
- Ophthalmology knowledge a bonus
- Ambulatory Surgery Center claim knowledge a bonus
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Health savings account
- Life insurance
- Paid time off