Medical Claim Specialist

Summary

The Medical Claims Specialist must have experience working with one or multiple payer sources. The successful candidate will possess a strong attention to detail and have effective communication skills. All tasks must be performed in a timely and accurate manner in accordance with Billing Office practices, policies and procedures.

Essential Duties:

• Review, identify and resolve claim denials

• Prepare and submit appeals for denied claims in a timely manner

• Follow up on claim denials

• Ability to read and understand EOB’s (Explanation of Benefits) with contract guidelines

• Follow up on outstanding claims

• Resolve claim issues for proper payment

• Contact insurance companies to resolve unpaid claims

• Correct claims for re-submission

• Process correspondence and scan documentation

• Identify claims that need to be escalated

• Review claims to ensure that appropriate reimbursement is received

• Maintain compliance & HIPPA regulations

 Skills & Qualifications:

• 1+ year experience as a claims specialist

• 1+ year medical billing

• Knowledge of CPT and ICD-10

• Detail Oriented

• Ability to work independently and prioritize

• Demonstrate problem solving skills

• Works well in a team environment

• Ability to work in a fast paced setting

• Excellent computer skills

• Proficient in knowledge of computer and MS Outlook