Medical Claims Specialist

1 week ago


Raleigh, United States Raleigh Orthopaedic Full time

Job Summary

The Medical Claims Specialist at Raleigh Orthopaedic is responsible for daily follow-up of Accounts Receivable, denials and appeals. This role requires strong communication skills to work with patients and insurance carriers to resolve billing and claims issues per individual carrier guidelines.

Key Responsibilities

  • Follow up on Accounts Receivable, denials and appeals in a timely manner
  • Communicate effectively with patients and insurance carriers to resolve billing and claims issues
  • Work with management and supervisors to resolve complex claims issues
  • Stay up-to-date with insurance carrier guidelines and coding requirements

Requirements

  • Three or more years' experience in medical insurance and billing in a clinic environment
  • Knowledge of insurance carrier guidelines with strong understanding of ICD-10, HCPCS and CPT coding
  • Experience with insurance software programs such as GE Centricity
  • Excellent problem-solving skills, attention to detail and organization skills

Preferred Qualifications

  • Coding certification

Working Relationships

The Medical Claims Specialist must be able to work in a cooperative manner and maintain effective working relationships with management/supervisors, co-workers, customers and vendors.



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