Medical Claims Review Specialist
Medical Claims Review Specialist
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USD 20 - 25
1 Vacancy
Job Description
OBJECTIVE:
To ensure that all charges claims and/or vouchers have been accurately submitted to the appropriate payers in a timely manner and that complete and accurate payment is received from all payers and selfpay patients.
ESSENTIAL DUTIES AND RESPPONSIBILITIES:
- Review claims submissions for accuracy by confirming proper payer authorizations referrals and all other key billing components.
- Follow clams from submission to payment using EMR analytics reports payer portals and other resources as necessary
- Partner with third party billing company personnel to resolve billing issues and support the effort of submitting clean claims with any research in a timely and responsive manner
- Review payer EOBs for a complete understanding of payments and assignment to patient responsibility.
- Use your knowledge of health insurance claim processing patient policies by payer and payer plan dynamics for commercial governmental workers compensation labor funds and others to assess accuracy of payments.
- Work diligently to resolve denied/rejected claims by researching and determining the causes of the unpaid claims and making every effort to resolve the denial/rejection in order to promptly resubmit to the payer.
- Respond to patient and/or insurer inquiries in a professional. timely efficient and knowledgeable fashion ensuring HIPAA and MOC guidelines are followed. and /or refunds as necessary.
- Work with billing department to ensure medical claims are coded correctly
- Other job tasks as necessary
COMPETENCIES:
- Experience using EMR EHR and other healthcare/billing related systems to include Allscripts Mod Med EPIC Exscribe Health IPass etc. Experience with web portals such as Availity
- Proficiency using Microsoft Excel
- Thorough knowledge of medical insurance terminology and payer explanation of benefits and experience working with medical benefit plans department of labor for workers comp claims
- Certified Medical Coder (surgery coding experience a plus)
- Experience with patient assistance and government programs such as Medicare and Medicaid
- Proficient at multitasking and managing competing priorities effectively.
- Effective written and oral communication.
EDUCATION AND EXPERIENCE REQUIRED:
- Minimum HS diploma college degree desired but not required
- Four years direct experience with core competencies
WORKING CONDITIONS/PHYSICAL DEMANDS:
- Must be able to sit and work at a computer for extended periods of time
- Requires manual finger dexterity and vision corrected to normal range
- Must be able to lift 25 lbs
Required Experience:
Unclear Seniority
Employment Type
Full-Time
