Medical claims specialist job description

Medical Claims Specialist – 100% REMOTE / Work From Home!!!

Our client is a national leader in business process as a service (BPaaS) in business process outsourcing (BPO) of medical claims in the Medicare Advantage and Managed Medicaid
markets.

Our client is looking for a number of full-time Medical Claims Specialists who will work 100% remote from their homes, which means they can live anywhere in the U.S. Our client DOES NOT provide sponsorship for U.S. employment, and candidates must be authorized to work in the U.S.

Our client’s corporate offices are located in the northern suburbs of Philadelphia.

This Medical Claims Specialist will be required to perform reviews of pended claims of all types and specialties, apply business rules, and finalize claims in accordance with regulatory and client expectations.

RESPONSIBILITIES of a Medical Claims Specialist:

• Perform timely and accurate claim adjudication and adjustments.
• Prepare encounters for submission and correct rejected encounters.
• Identify opportunities to improve efficiency within assigned processes.
• Research and review Claims Appeals information to support client inquiries.
• Support system inquiries documented from the member and provider call center services.
• Adjudicate specialty claims, including ambulatory surgery, skilled nursing, dental, anesthesia, medical assistance, reprocessed claims, duplicate claims, ambulance, durable medical equipment (DME), or institutional-based charges.

REQUIREMENTS of a Medical Claims Specialist:

• 1 to 3 years of Medicare Advantage and Managed Medicaid experience.
• Experience in working in a remote BPaaS environment with performance standards.
• Excellent attention to detail and phone communication skills.
• Excellent written communication skills.
• Proficient with Microsoft Office Outlook, Word and Excel, and Adobe Standard.

This Medical Claims Specialist position provides an hourly range of $14.00 to $17.50 per hour commensurate with experience along with benefits that include: Medical (pays 75% of selected coverage), Dental, 401(k) with match, Life, STD, LTD, 5 weeks PTO, and 10 paid Holidays.

**PLEASE APPLY TO BE CONSIDERED**

• Reviews claims for accuracy prior to claim submission
• Ensures the required supporting documentation is on file prior to claim submission as determined by the company and/or the insurance plan/government payer
• Identifies and resolves claim rejections
• Identifies and resolves claim denials
• Maintains a working knowledge of the payer’s appeals process
• Mark accounts for no bill when irregular conditions cannot be resolved before billing/timely filing date.
• Identification and recommendation for resolution for payer trends preventing or delaying payment working with management to resolve.
• Submits accurate electronic and CMS 1500 paper claims in accordance with company and payer guidelines.
• Adherence to established productivity and quality thresholds
• Provides recommendations for continued improvement to the billing process.
• Adhere to departmental and company policies and procedures

QUALIFICATIONS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily and must possess the ability to: interact professionally and ethically with third parties including insurance plans, patients, and caregivers as well as with co-workers and management; handle multiple tasks simultaneously; Provide clear, concise oral and written directives/communications; Quickly assess situations and respond appropriately; Handle special requests in a sensitive, professional manner. Demonstrates the ability to problem solve, prioritize and organize. Ability to follow directives with accuracy and precision; Assist with and participate in fostering a team environment.

The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION AND/OR EXPERIENCE:

• High School diploma and 1-3 years of medical billing experience
• Detail oriented individual with medical billing and collections experience.
• Experience billing commercial insurance, Medicare parts B and C as well as Medicaid claims.
• Durable Medical Equipment experience preferred.
• Experience & knowledge of Brightree billing software preferred.
• Proficiency with Microsoft Office including Excel a plus.

TRAINING:

Our industry is a highly regulated industry, and because of that and our commitment to providing the best in class products, services, and support, we require ALL employees to complete the following training programs prior to acting on behalf of the organization to bill or collect products, services, and support systems which we supply:

A. Fraud, Abuse, and Waste Training

B. HIPAA Training

C. Sales Training

D. Systems Training

Medical Claims - Healthcare Customer Service

Our client, a large 3rd party Administrator that processes accurate payments for thousands of individuals, is seeking candidates to help with their claims payments. This is a team that supports the West Coast; Please note the schedule below.

Monday through Friday 40 hours per week: 3 days will be 11: 30am to 8: 00 am and 2 days 9: 30am to 6: 00pm (M-F) 40 hours.

Pay: $18.50 to $20.00 Per Hour

Easy to get too, Rural town, Free Onsite Parking, Café in Building!

Job Responsibilities:

This is a fast paced / high volume interaction department that answer phones and respond to client inquiries related to payments made on their behalf to insurers or medical providers.

• Make outgoing calls to clients, medical providers, insurance companies to resolve coding, payment, billing, and documentation clarification.
• Identify, research and resolve client issues.
• Familiarity with follow up letters approval and denial letters
• Uses knowledge of Medicare, Medicaid and commercial insurance along with primary and secondary insurance claims

Required Skills:

• Experience with Medical Insurance including- Insurance follow up / Medical billing and payment / Billing resolution/ Insurance Claims
• Understanding of Medicare, Medicaid, commercial insurance and secondary insurance
• Ability to read and understand missing Clinical Documentation, Clinical coding Enrollment; and Payment Terms related to insurance premiums and out of pocket expenses; Benefits Coordination with other insurance coverage.
• STRONG COMMUNICATION SKILLS– This is a highly interactive role . The chosen candidate will have experience with customer service/ call center experience from an Insurance, billing or medical processing payment environment.
• Technology and Computer Skills: Proficiency with all MS Office applications (Excel, Word, Outlook, etc.) Billing and Insurance Software

Work for a highly rated Recruiting & Staffing Firm by Google and Forbes!

INDH