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Medical Claims Integrity Specialist
1 month ago
Join to apply for the Medical Claims Integrity Specialist role at Unity Health Care3 weeks ago Be among the first 25 applicantsJoin to apply for the Medical Claims Integrity Specialist role at Unity Health CareThis range is provided by Unity Health Care. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.Base pay range$24.95/hr - $31.19/hrINTRODUCTIONWe are searching for a dedicated and detail-oriented Medical Claims Integrity Specialist to join our team. The ideal candidate will have a strong background in medical billing and knowledge of coding, as well as a thorough understanding of insurance policies and procedures. This role involves reviewing and processing medical claims, ensuring accuracy and compliance with all relevant regulations. This position requires excellent communications skills, as well as the ability to work independently and manage multiple tasks simultaneously. The successful candidate will be responsible for maintaining accurate records, identifying discrepancies, and ensuring timely reimbursement of medical services.Major Duties/Essential FunctionsReview and process both professional and institutional medical insurance claims.Process medical claims within established timelinesEnsure accuracy and compliance with relevant regulations.Identify and scrub discrepancies in claims.Stay updated on changes in insurance policies and procedures.Collaborate with other team members to improve claims processing efficiency.Verify patient insurance coverage when needed.Participate in audits and quality assurance activities.Maintain confidentiality of patient information.Adhere to all company policies and procedures.Perform other duties as assigned.QualificationsHigh School diploma or GED required/Associates’ degree preferred.Proficient in ICD 10, CPT, and HCPCSMinimum of 4 years of experience in medical claims processing (multi-specialty experience preferred).Knowledge, Skills, And Abilities RequiredAbility to analyze, identify and resolve any discrepancies during the claims processAbility to work in a fast-paced environmentStrong understanding of medical terminology and insurance policies.Excellent analytical and problem-solving skills.Attention to detail and accuracy in data entry.Ability to work independently and as part of a team.Proficient in Microsoft Office Suite and claims processing software.Strong communication and interpersonal skills.Ability to handle confidential information with discretion.Knowledge of regulatory requirements related to health insurance claims.Experience with electronic health records (EHR) systems.Ability to manage multiple tasks and meet deadlines.Strong organizational skills and attention to detail.Excellent data EntryCommitment to continuous learning and professional developmentSUPERVISORY CONTROLSThis position reports directly to the Medical Coding Manager.GUIDELINESThe position abides by all rules and regulations set forth by applicable licensing and regulatory bodies and the UHC policies and procedures.PERSONAL CONTACTSPrimary contact is with the employees and potential employees of UHC Health Centers and DOC sites but may also include external customers.PHYSICAL DEMANDSRefer to ADA Checklist.WORKING CONDITIONS AND PHYSICAL EFFORTRefer to ADA Checklist.Other Significant FactsThe incumbent must be able to balance the needs of diverse constituencies on a daily basis.RISKSThe position involves everyday risk and discomforts, which require normal safety pre-cautions typical of such places as offices, meetings, training rooms, and other UHC health Care Sites. The work area is adequately lit, heated, and ventilated. The position requires contact with staff at all levels throughout the organization. There are also external organization relationships that may be part of the work of this individual. All medical services shall be provided according to medically accepted community standards of care. The employee shall provide evidence of recent (within the past twelve (12) months) health assessment that includes a PPD and/or chest x-ray results.The statements contained herein describe the scope of the responsibility and essential functions of this position, but should not be considered an all-inclusive listing of work requirements. Individuals may perform other duties as assigned including work in other areas to cover absences or relief to equalize peak work periods or otherwise balance the workload.Seniority levelSeniority levelMid-Senior levelEmployment typeEmployment typeFull-timeJob functionJob functionHealth Care ProviderIndustriesHospitals and Health CareReferrals increase your chances of interviewing at Unity Health Care by 2xSign in to set job alerts for “Medical Specialist” roles.Special Agent: Healthcare Services /Medical BackgroundWashington DC-Baltimore Area $99,461.00-$128,329.00 1 week agoDistrict of Columbia, United States 1 month agoArlington, VA $44,000.00-$50,000.00 1 month agoEntry-Level Healthcare Position (PCA) - Training ProvidedEntry Level Healthcare - Training ProvidedASSISTANT MEDICAL EXAMINER, NON BOARD CERTIFIEDEntry-Level Healthcare Position - Training ProvidedEntry Level Healthcare - Training ProvidedEntry-Level Healthcare Position (PCA) - Training ProvidedEntry Level Healthcare - Training ProvidedSilver Spring, MD $15.00-$23.01 2 weeks agoChantilly, VA $44,000.00-$50,000.00 1 month agoWe’re unlocking community knowledge in a new way. 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