Medical Claims Specialist

DESCRIPTION
We are looking for a motivated performer to join our Business Office team as a Medical Collector

JOB SUMMARY

· Ongoing follow-up and review of all payer accounts

· Must work each account at least once a month

· Check receipt of electronic claims within 7 days of bill date

· Process documentation for accounts which fall into an appeals status and properly note the account

· Follow up on all denials timely

· Informs the Business Office Manager of any payer trends

· File all completed EOB’s in the correspondence folder by date worked and note account in PAS (Patient Accounting System)

· Prepare coding review forms with all data for review by Coder

· Correct patient demographic and insurance information when necessary and generate re-bill

· Knowledge of insurance contracts and timely filing deadlines

· Knowledge of ICD10 codes and CPT codes

· Must be able to verify insurance benefits

· Initiates authorizations when needed

· Work with biller and coding team on insurance denials and coding issues

· Receives, screens, and routes incoming calls in a professional manner

· Prepares patient and insurance refunds

· Prepares accounts for collections turnover

· Informs Business Office Manager of applicable day-to-day situations

· Processes all outgoing mail, runs through postage machine and delivers to mailbox on a daily basis.

· Ability to work as a team member

· Must be flexible, reliable, productive, patient oriented and self-motivated

· Follows all facility policies and procedures

· Comply with all HIPAA regulations

 
  
BENEFITS
Our competitive salary and benefits package includes medical and dental insurance, 401(k), paid time off and life insurance.

EDUCATION, TRAINING AND EXPERIENCE REQUIREMENTS:
Previous collections experience, with emphasis on healthcare insurance collections of all types. Preference shown to previous experience in an ambulatory surgical setting.
Medical terminology.
Knowledge of ICD10 codes and CPT codes
Ability to work independently.
Excellent Communication skills and interpersonal skills.
Skilled in time management and prioritization of emergent situations.
Good customer service skills, always demonstrates professionalism.
Comfortable utilizing critical thinking skills.
Typing 45-60 WPM.
High School Diploma or equivalency.
Proficient with Microsoft Office products.
Experience with electronic patient information systems.
Prefer previous experience with Electronic Health Record system.