Growing Medical Center seeks Medical Claims Specialist Duties to Include: ?Obtaining referrals and pre-authorizations as required for procedures. ?Checking eligibility and benefits verification for treatments, and procedures. ?Reviewing patient bills for accuracy and completeness, and obtaining any missing information. ?Preparing, reviewing, and transmitting claims using billing software, including electronic and paper claim processing. ?Following up on unpaid claims within standard billing cycle timeframe. ?Checking each insurance payment for accuracy and compliance with contract discount. ?Calling insurance companies regarding any discrepancy in payments if necessary ?Identifying and billing secondary or tertiary insurances. ?Reviewing accounts for insurance of patient follow-up. ?Researching and appealing denied claims. ?Answering all patient or insurance telephone inquiries pertaining to assigned accounts. ?Setting up patient payment plans and work collection accounts. ?Updating billing software with rate changes. ?Run collection reports REQUIRED SKILLS ? Computer experience is essential, including, but not limited to: practice management software, word processing and spreadsheet applications. ? Experience in CPT and ICD-10 coding; familiarity with medical terminology. Working knowledge of EMR and EClinical software ? Excellent customer service skills. ? Strong written and verbal communication skills. ? Experience in filing claim appeals with insurance companies to ensure maximum entitled reimbursement. Knowledge of insurance guidelines including PPO, Medicare, Medicaid, and other payer requirements and systems. ? Ensure all claims are submitted with a goal of zero errors. ? Verifies completeness and accuracy of all claims prior to submission. ? Accurately Post all insurance payments by line item. ? Timely follow up on insurance claim denials, exceptions or exclusions. ? Reading and interpreting insurance explanation of benefits. ? Utilize monthly aging accounts receivable reports to follow up on unpaid claims aged over 30 days. ? Make necessary arrangements for medical records requests, completion of additional information requests, etc. as requested by insurance companies. ? Respond to inquiries from insurance companies, patients and providers.
Medical Claims EClinical Healthcare
Employment Type: Temporary-to-full-time