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Medical Billing Claims Specialist, Claims Specialist

3 months ago

Richardson, United States The Warren Center Full time
Job DescriptionJob Description

Summary

Reporting directly to the Revenue Cycle Manager, the Medical Billing – Claims Specialist supports the overall mission of The Warren Center by effectively ensuring accurate medical billing claims, timely submission of electronic and/or paper claims, monitoring claim status, researching rejections and denials, documenting related account activities, posting adjustments and insurance and patient collections.

Essential Duties and Responsibilities

To perform this job successfully, an individual must be able to perform the following satisfactorily.

Primary Functions

  • Coordinates and clarifies with providers, when necessary, on information that seems incomplete or is lacking for proper account/claim adjudication
  • Responsible for correcting, completing, and processing claims follow up for all payer codes
  • Knowledge of medical terminology, ICD 9/10, HCPCS codes, CPT codes, modifiers
  • Read and interpret EOBS & Remittance Advice
  • Knowledge of how to navigate through medical EMR systems and clearinghouses
  • Familiar with processing claims, appeals, reconsiderations, denials, rejections, and submitting write-offs.
  • Collecting and managing all patient responsibilities such as copays, co-insurance, deductible, and account balances.
  • Knowledge of insurance verification and authorizations
  • Knowledge of Medicaid and private insurance.
  • Knowledge of locating, scanning, and submitting medical records
  • Able to perform in high volume atmosphere.
  • Assist in billing audits
  • Performing follow up on medical billing claims.
  • Identify trends, and carrier issues relating to billing and reimbursements and report findings Medical Billing Manager
  • Knowledge of HIPPA rules and violations for patient confidentiality 
  • Other departmental tasks as assigned

Reception Practices (backup)

  • Ensure that all internal and external customers are treated with respect, provide knowledgeable answers, and a welcoming attitude
  • Answer incoming billing, claims, account balance and status calls appropriately
  • Intra-office and organizational communication regarding account data and claims

Education and Experience

  • High school diploma or General Educational Development (GED) diploma
  • 3+ experience in medical billing with focus in claims filing
  • Experience with ProviderSoft medical software preferred

Additional Technical Skills, Traits and Knowledge

To perform this job successfully, an individual must be able to perform each qualification satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

  • High energy and passion for The Warren Center’s mission is essential
  • Professional, dependable, and proactive
  • Strong interpersonal and communication skills, both verbal and written
  • Must possess excellent time management and organizational skills
  • Appropriate data and word processing skills
  • Ability to use basic office technology equipment
  • Demonstrate critical thinking, creativity, problem solving and decision-making skill
  • Ability to read, write, perform math and accounting functions, and proof-read

Environment

The physical requirements and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions of the job. 

  • Frequently required to use hands to finger, handle, or feel, and use keyboard as well as see, talk or hear
  • Occasionally required to stand and move around for work
  • Moderate stress level
  • Long periods of sitting
  • The noise level in the work environment is usually moderate in a shared work space

EQUAL OPPORTUNITY EMPLOYER

The Warren Center is an Equal Opportunity Employer and we believe in an inclusive culture for all. The Warren Center provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Company DescriptionAt The Warren Center, our mission is to advocate, serve and empower children and families impacted by developmental delays and disabilities.

We help children to reach their developmental goals through individualized therapy-based care and equip parents through monthly education workshops and support groups so they can be a confident advocate for their child.

1. Early Childhood Intervention (ECI): Serving over 1,000 each month, this program provides evaluations and personalized therapy sessions to children from birth to three years of age and includes occupational and physical therapy, speech and language therapy, feeding and nutrition therapy, developmental therapy, and transition assistance to additional services.

2. The Warren Center Clinic Therapy Services: This program served 163 children last fiscal year. We enroll children aged three to five, and continue to serve them as they get older. Our licensed speech-language pathologists, occupational therapist and physical therapist focus on communication, social, sensory, and motor/ coordination skills utilizing our sensory gym, outdoor therapy yard, motor room, small therapy rooms and group classroom.

3. We also help parents whose children are in a program with family education and support services which include monthly education workshops, respite care and support groups – plus guidance to other needed services and resources.

The Warren Center ECI program has a service area of 48 zip codes including Addison, Carrollton, Coppell, Farmers Branch, Garland, Irving, Lake Highlands, Lakewood, North Dallas, Park Cities, Richardson, Rowlett, Sachse, and Wylie. We have three office locations in Richardson, Garland, and Carrollton. We make referrals to any family who needs help regardless of their city of residence.

Our Clinic Therapy Services and Family Education & Support Services is open to the entire DFW Metroplex and is not dependent on location.Company DescriptionAt The Warren Center, our mission is to advocate, serve and empower children and families impacted by developmental delays and disabilities.\r
\r
We help children to reach their developmental goals through individualized therapy-based care and equip parents through monthly education workshops and support groups so they can be a confident advocate for their child.\r
\r
1. Early Childhood Intervention (ECI): Serving over 1,000 each month, this program provides evaluations and personalized therapy sessions to children from birth to three years of age and includes occupational and physical therapy, speech and language therapy, feeding and nutrition therapy, developmental therapy, and transition assistance to additional services.\r
\r
2. The Warren Center Clinic Therapy Services: This program served 163 children last fiscal year. We enroll children aged three to five, and continue to serve them as they get older. Our licensed speech-language pathologists, occupational therapist and physical therapist focus on communication, social, sensory, and motor/ coordination skills utilizing our sensory gym, outdoor therapy yard, motor room, small therapy rooms and group classroom.\r
\r
3. We also help parents whose children are in a program with family education and support services which include monthly education workshops, respite care and support groups – plus guidance to other needed services and resources.\r
\r
The Warren Center ECI program has a service area of 48 zip codes including Addison, Carrollton, Coppell, Farmers Branch, Garland, Irving, Lake Highlands, Lakewood, North Dallas, Park Cities, Richardson, Rowlett, Sachse, and Wylie. We have three office locations in Richardson, Garland, and Carrollton. We make referrals to any family who needs help regardless of their city of residence.\r
\r
Our Clinic Therapy Services and Family Education & Support Services is open to the entire DFW Metroplex and is not dependent on location.