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Medical Specialist-Claims
2 months ago
*Description:*
*Process daily tasks assigned from the billing software system.
*Enter and process data related to patient care and reimbursement.
*Check to ensure all patient documents are on file and completed correctly.
*Connect with insurance payors by telephone or online regarding non-payment or short payment on outstanding claims. Respond to insurance payor correspondence.
*Review and resubmit simple corrections to low dollar claims to payors for reprocessing.
*Work AR aging reports for payors.
*Review claims forms to primary, secondary, and tertiary insurance payors as needed.
*Work accounts promptly to ensure claims are processed appropriately.
*Provide exceptional customer service to all internal and external customers.
*Review HCPC, modifiers, and ICD-10 codes for accuracy while keeping up with compliance and coverage criteria to update employees as needed.
*Meets work standards by following productivity, quality, and customer service standards established by the company.
*Complies with Corporate Compliance and HIPAA responsibilities.
*Perform other duties and special projects as assigned.
Knowledge, Skills, and Abilities:
*Experience with HCPC, ICD-10 medical terminology, accounts receivable, insurance collections and payor requirements, or billing.
*Ability to work quickly and accurately and pay attention to detail.
*Proficient with Microsoft Office Software- Excel, Word and Outlook and databases.
*Strong data entry skills.
*Ability to work in a fast-paced environment.
*Communicate clearly, both verbally and in writing, with clinical and non-clinical personnel, patients, and care givers in a professional and respectful manner.
*Demonstrate organizational, analytical, and time management skills.
*Dependable, reliable, and punctual.
Minimum Qualifications - (Education, Experience, Certification, & Licensure):
*High school diploma or equivalent qualification required.
*Minimum 1 year of experience in accounts receivable, claims, and insurance payor requirements.
*Familiarity of Medicare and Medicaid preferred.
*Knowledge of Orthotics, Prosthetics, and DME a plus preferred.
About TEKsystems:
We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
