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Medical Claims Processing Specialist

2 months ago

Orlando, Florida, United States Blue Star Partners LLC Full time
Job Overview

Position: Medical Billing Specialist
Company: Blue Star Partners LLC
Contract Type: W-2

Role Summary:

The Medical Billing Specialist plays a crucial role in our organization, contributing to the achievement of our financial objectives. This position demands a broad range of skills to effectively communicate, negotiate, analyze, and resolve billing issues with both payers and patients while strictly adhering to HIPAA and PHI regulations.

Key Responsibilities:

  • Ensure compliance with HIPAA and PHI regulations throughout all stages of client information processing, promptly reporting any compliance concerns to management.
  • Oversee the insurance verification process, ensuring clients are informed about their co-pay obligations and following up as needed to facilitate collections.
  • Collect payment information from clients and accurately input it into the billing system.
  • Timely manage the entry of client data into the system, reaching out to necessary parties to gather any missing information.
  • Confirm all sales orders in the system, ensuring all required documentation is complete before submitting claims.
  • Regularly follow up on outstanding sales orders and resolve billing inquiries until payment is received.
  • Submit claims to payers in a timely manner, addressing any rejected claims as necessary.
  • Ensure accurate posting of payments to the appropriate accounts.
  • Generate invoices and follow up with clients and payers to collect outstanding payments.
  • Stay informed on current regulatory guidelines and reimbursement practices to ensure accurate billing.
  • Assist with additional duties and projects as assigned, including customer service support and inquiry resolution.

Essential Skills and Qualifications:

  • Strong attention to detail to ensure accuracy in all tasks.
  • Excellent communication and interpersonal skills.
  • Proficient in documenting accounts with clarity and analytical thinking.
  • Ability to interpret explanations of benefits (EOB).
  • Strong analytical skills for effective management of collections.
  • Familiarity with medical billing tools and systems.
  • Proven problem-solving abilities to navigate challenges in the billing process.
  • Exceptional customer service skills to foster positive relationships with clients and payers.
  • Effective time management skills to prioritize tasks and meet deadlines.
  • Consistent attendance and reliability.

Education and Experience Requirements:

  • At least 2 years of experience in medical billing or a related field.
  • Proficiency in medical billing software.
  • Understanding of HIPAA and PHI regulations.
  • Experience with insurance verification and co-pay collection processes.
  • Proven ability to accurately manage client information in billing systems.
  • Familiarity with claim submission processes and handling rejected claims.
  • Strong communication skills for effective interaction with clients and internal teams.
  • Experience in customer service and inquiry resolution.
  • Ability to work independently and collaboratively in a fast-paced environment.
  • Relevant training or certification in medical billing is advantageous.