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Medical Claims Specialist
4 months ago
SUMMARY
We are seeking a self-motived, high achiever, to join our team. Bright Futures Psychiatry is 100% PMHNP owned (Female, Air Force Veteran). We know our work is vital to the success of our community, hence we take our work very seriously. We celebrate our victories and learn as much as possible from any failures.
Our goal is to remove all barriers to care and deliver high-quality mental healthcare in a timely fashion. At Bright Futures Psychiatry you will find a sense of belonging that promotes collaboration between our providers and our various support teams. Our company culture is one of warmth and inclusivity to both staff and clients.
The Medical Claims Specialist (MCS) plays a vital role in the day-to-day operations of Bright Futures Psychiatry. The MCS is responsible for posting payments to client accounts, reviewing claims for coding accuracy, reviewing and analyzing denied claims from insurance companies and taking the necessary actions to appeal or resolve the denial. This role requires a strong understanding of medical coding, billing, and insurance policies.
JOB SUMMARY
The MCS will be responsible for posting payments to client accounts, reviewing claims for coding accuracy, reviewing and analyzing denied claims from insurance companies and taking the necessary actions to appeal or resolve the denial.
KEY RESPONSIBILITIES
- Review and analyze claims for coding accuracy.
- Review and analyze denied medical claims to determine the reason for the denial.
- Collaborate with healthcare providers, insurance companies, and other stakeholders to gather necessary information for appeal or resolution of the denial.
- Develop and submit appeals for denied claims within the specified time frame.
- Follow up on appeals and ensure that they are resolved in a timely manner.
- Identify trends in denials and works to implement process improvements.
- Provide guidance and support to healthcare providers and staff on the appeals process.
- Ensure that all appeals are properly documented in the electronic medical records system.
- Post payments to client accounts.
- Stay up-to-date on changes to medical coding, billing, and insurance policies.
- Other duties as assigned.
QUALIFICATIONS
- High school diploma or equivalent required, college degree preferred.
- At least 2 years of experience in medical claims management (psychiatric preferred).
- Ability to work on-site in our Colorado Springs, CO office.
- Strong understanding of medical coding and billing practices.
- Detail-oriented with strong analytical and problem-solving skills.
- Familiarity with electronic medical records systems and other healthcare software.
- Knowledge of insurance policies and regulations.
PHYSICAL REQUIREMENTS
- The MCS may need to spend extended periods of time sitting at a desk and using a computer.
- Some travel may be required for meetings in office if working in a hybrid position.
- The employee must occasionally lift and/or move 20 pounds.
- Specialized equipment, machines, or vehicles used: Computers, copiers, and other standard office equipment.
BENEFITS
- Pay range: $21.55 - $25.17 hourly rate
- $2,500 Sign On Bonus (qualification based on merit and conditions)
- Productivity Bonuses (paid quarterly)
- Bright Futures Psychiatry pays 100% of your Medical, Dental, and Vision monthly premiums.
- 401k + 5% Match
- Paid Holidays + Birthday Holiday
- Opportunity to get Quarterly Goals Bonuses
REASON YOU SHOULD WANT TO WORK WITH BRIGHT FUTURES PSYCHIATRY: We treat every member of our organization with respect and support one another as valuable teammates. We continue to grow because the need for mental health services has not been met yet in Colorado... we aim to meet this need. If you are interested in being part of a team that is actually making a difference in Colorado, you should apply, now.
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