Medical Specialist-Claims

Description:

• Process daily tasks assigned from the billing software system.

• Enter and process data related to patient care and reimbursement.

• Check to ensure all patient documents are on file and completed correctly.

• Connect with insurance payors by telephone or online regarding non-payment or short payment on outstanding claims. Respond to insurance payor correspondence.

• Review and resubmit simple corrections to low dollar claims to payors for reprocessing.

• Work AR aging reports for payors.

• Review claims forms to primary, secondary, and tertiary insurance payors as needed.

• Work accounts promptly to ensure claims are processed appropriately.

• Provide exceptional customer service to all internal and external customers.

• Review HCPC, modifiers, and ICD-10 codes for accuracy while keeping up with compliance and coverage criteria to update employees as needed.

• Meets work standards by following productivity, quality, and customer service standards established by the company.

• Complies with Corporate Compliance and HIPAA responsibilities.

• Perform other duties and special projects as assigned.

Knowledge, Skills, and Abilities:

• Experience with HCPC, ICD-10 medical terminology, accounts receivable, insurance collections and payor requirements, or billing.

• Ability to work quickly and accurately and pay attention to detail.

• Proficient with Microsoft Office Software- Excel, Word and Outlook and databases.

• Strong data entry skills.

• Ability to work in a fast-paced environment.

• Communicate clearly, both verbally and in writing, with clinical and non-clinical personnel, patients, and care givers in a professional and respectful manner.

• Demonstrate organizational, analytical, and time management skills.

• Dependable, reliable, and punctual.

Minimum Qualifications – (Education, Experience, Certification, & Licensure):

• High school diploma or equivalent qualification required.

• Minimum 1 year of experience in accounts receivable, claims, and insurance payor requirements.

• Familiarity of Medicare and Medicaid preferred.

• Knowledge of Orthotics, Prosthetics, and DME a plus preferred.