Medical Claims Specialist

You will be responsible for collections, account follow up, billing and allowance posting for the accounts assigned.

Duties and Responsibilities:
• Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or websites.
• Meets and maintains daily productivity/quality standards established in departmental policies.
• Uses the workflow system, client host system and other tools available to them to collect payments and resolve accounts.
• Adheres to the policies and procedures established for the client/team.
• Knowledge of timely filing deadlines for each designated payer.
• Performs research regarding payer specific billing guidelines as needed.
• Ability to analyze, identify and resolve issues causing payer payment delays.
• Ability to analyze, identify and trend claims issues to proactively reduce denials.
• Communicates to management any issues and/or trends identified.
• Initiate appeals when necessary.
• Ability to identify and correct medical billing errors.
• Send appropriate appeals, accurate requesting information, supporting documentation, and effective communication to complete recovery process.
• Understanding of under or over payments and credit balance processes.
• Assist with special A/R projects as needed. Analytical skills and the ability to communicate results are required.
• Act cooperatively and courteously with patients, visitors, co-workers, management and clients.
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
• Work independently from assigned work queues.
• Maintain confidentiality at all times.
• Maintain a professional attitude.
• Other duties as assigned by the management team

Qualifications:
• Completed at least High School education
• With minimum 1 year of Healthcare Account Receivable/Collections in a BPO setting or environment (claims payments processing, claims status and tracking, Medical Billing, AR Follow ups, Denials and Appeals-outbound healthcare providers)
• Experienced on medical billing/ AR Collections.
• Background in calling insurance (Payer) to verify claim status and payment dispute.
• Must be amenable to work onsite and night shift.