Medical Claims Reconciliation Specialist - Remote (Pa And Nj Residents Only)

Summary

The Medical Claims Reconciliation Specialist ensure the payment of claims in full within 30-60 days from the date of service, manages follow up on denied claims and rejections daily to avoid timely filing deadlines. The ADL Medical Claims Reconciliation Specialist is meticulous, conscience, professional, diligent, a skilled communicator, and always puts the Client and Patient first recognizing and practicing ADL?s view that, ?there is a person behind every sample.?

Work From Home state location requirements: Pennsylvania, New Jersey (within one hour from Bensalem Pa)

Training on-site in Bensalem (approximately 2 weeks)

Essential Functions:

• Read and understand explanations of benefits (EOB) and denial reason to effectively perform billing functions.
• Knowledge of CARC and RARC codes.
• Knowledge of ICD-10 diagnosis coding.
• Knowledge of all payers timely filing limits.
• Manage and maintain your Work ques within 2 weeks of date of submission.
• Communicate with management on any updates needed for CPT Codes, Bundling Panel Codes, incorrect NPI numbers, CLIA numbers of issue, or any other issue that requires a change in operations/programming.
• Follow-up on claim status.
• Prepare and send appeals within timely filing limits.
• Field telephone calls through the telephone application (calls answered by the entire billing team).
• Payment posting including reconciliation.
• Perform additional duties as requested by management.

Guidelines - Work from Home

Ninety-five percent remote 5% in office at the discretion of management

• Workdays are Monday through Friday. Work hours will be in your job description. Flexibility with schedule is available with prior documented approval of management.
• Training onsite will require one day.
• In compliance with ADL?s HIPAA compliance policy, Work from Home refers to ?work from your home? only.
• Provide a quiet work area free from all distraction.
• Attend scheduled virtual departmental meetings.
• On-site department meetings announced at least 4 days in advance.
• Maintain proper business attire during virtual meetings.
• Maintain professional demeanor during phone calls with clients and ADL team members, and during virtual meetings.
• Payroll system time tracking daily at the beginning and end of each daily shift.
• Work From Home state location requirements: Pennsylvania, New Jersey