Medical Claims Specialist

2 days ago

Snow Hill, United States Contentnea Health Full time
{"Job Title": "Medical Claims Specialist", "Job Summary": "At Contentnea Health, we are seeking a skilled Medical Claims Specialist to join our team. As a Medical Claims Specialist, you will play a critical role in ensuring timely and accurate payment for medical services provided to our patients. Your expertise in billing processes and practices will enable you to research and correct denials and errors, apply discounts and adjustments, and resubmit claims as needed.

Responsibilities:

* Perform billing and collection activities for medical, behavioral health, and dental services.
* Create claims submissions for assigned payers and/or patient accounts.
* Correct and resubmit rejected claims for assigned payers and/or patient accounts.
* Research, correct, and resubmit denied claims for assigned payers and/or patient accounts.
* Follow up with payers via the most effective channel to resolve outstanding claims, including filing appeals and reconsideration requests.
* Identify credit balances for assigned payers and/or patient accounts, research, and verify accuracy of credit balance and submit refund requests as appropriate.
* Identify account balances meeting the criteria for bad debt write-off, research, and verify accuracy of balance and flag balances as appropriate to be written off as bad debt.
* Post third-party payments for assigned payers and/or patient accounts accurately to charges.
* Review account balances for patients qualified for the Sliding Fee Discount Program and apply discounts to eligible patient charges.
* Perform work in accordance with departmental timelines for claims creation, submission, resolution of claim rejections and denials, and open/unpaid claims.
* Assist with reconciliation of patient and payer payments as requested.
* Communicate with credentialing staff and/or external credentialing vendor as needed to ensure necessary enrollments and/or updates are performed to mitigate claims denials.
* Maintain all documents relevant to daily billing functions in internal data repository, e.g., remittance advices, payer correspondence, fee schedule, billing/coding rules, W9 forms, memos, charge slips, training documents, etc.

Qualifications and Skills:

* Possesses specific knowledge and training in billing processes and practices, typically acquired during completion of a certificate program in billing practices with a duration of up to a year.
* Possesses a basic knowledge of medical terminology, procedural and diagnostic coding, medical-dental cross-coding, electronic claims processing, and of insurance policies and contracts for multiple insurance vendors.
* Current certification as a Community Health Coding and Billing Specialist (CH-CBS).

If you are a detail-oriented and organized individual with a passion for healthcare and billing, we encourage you to apply for this exciting opportunity.

At Contentnea Health, we offer a dynamic and supportive work environment, competitive compensation, and opportunities for professional growth and development.

Apply today and take the first step towards a rewarding career in healthcare"}

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