Medical Claims Specialist
Responsible for the collection of accounts receivable for major hospital clientele. Performs telephone and written follow-up with patients, insurance companies, third party payers, worker’s compensation payers, medical groups, outside hospitals and physician’s offices to ensure timely payments. Has a strong understanding of CMS regulations, Managed Care and insurance company payment principles, rules, and regulations. Is knowledgeable with the use of appropriate HCPCS, CPT 4 codes, Modifiers, ICD9 and ICD10 codes.
Understands the billing and payment follow up time limits set forth by Medicare, payer contracts and has the knowledge of insurance billing rules and regulations. Has the ability to utilize multiple hospital systems. Performs other duties as needed.
Responsibilities
- Responsible for the collection of accounts receivable for major hospital clientele.
- Performs telephone and written follow-up with patients, insurance companies, third party payers, worker’s compensation payers, medical groups, outside hospitals and physician’s offices to ensure timely payments.
- Has a strong understanding of CMS regulations, Managed Care and insurance company payment principles, rules, and regulations.
- Is knowledgeable with the use of appropriate HCPCS, CPT 4 codes, Modifiers, ICD9 and ICD10 codes.
- Understands the billing and payment follow up time limits set forth by Medicare, payer contracts and has the knowledge of insurance billing rules and regulations.
- Has the ability to utilize multiple hospital systems. Performs other duties as needed.
Skills/Experience
- Limited experience at Medical Collections preferred;
- Great interpersonal communication skills;
- Keen eye for spotting data trends;
- Great analytical skills;
- A keen grasp of information technology;
- Professional demeanor;
- Personal accountability and strong work ethic;
- Professional, able to interact with vendors/clients;
- Positive, “can do” attitude.
- Minimum 2+ Years experience