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Medical Claim Denial Specialist
2 months ago
Location: Port Saint Lucie
Department:
Work Location: Port Saint Lucie, FL
Onsite Days: Thursday and Friday
The Medical Claim and Denial Specialist is responsible for generating revenue by the timely processing and submission of clean medical claims to all payers including insurance companies, federally subsidized government plans such as Medicare Parts B and C, Medicaid, Medicaid Managed, as well as patient billing. The Medical Claim and Denial Specialist is also responsible for reviewing reports/work queues to identify and to correct the root cause for claim rejections, and denials which might prevent or delay payment of a particular claim or group of claims.
Responsibilities:
Include the following as well as other duties and responsibilities, which may be assigned:
-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.
Minimum Qualifications:
-High School Diploma or equivalent
-1-3 years of medical cash application, medical billing or collections experience
-Experience posting insurance, Medicare parts B and C as well as Medicaid payments, adjustments, and refunds
-Demonstrated ability to multitask, problem solve and prioritize tasks
Preferred Qualifications:
-Durable Medical Equipment experience
-Experience with Brightree billing software or equivalent
-Proficiency with Microsoft Office including Excel
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Here’s what we have to offer:
-Variety of Medical, Dental and Vision Insurance Plans
-401k Plan with Company Match
-PTO and Paid Holidays
-EAP
-Employee Discounts
Job Req ID: 33339
EOE Statement:
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
Accommodations Statement:
ABC Medical endeavors to make abc-med accessible to any and all users. If you would like to Apply regarding the accessibility of our website or need assistance completing the application process, the ABC Medical HR Department at # This contact information is for accommodation requests only and cannot be used to inquire about the status of applications.
