Medical Claims Specialist

2 months ago


Phoenix, Arizona, United States SOUTHWEST BREAST AND AESTHETICS LLC Full time
Job Summary

We are seeking a highly skilled Medical Claims Specialist to join our team at Southwest Breast and Aesthetics LLC. As a Medical Claims Specialist, you will be responsible for accurately and efficiently processing medical claims, resolving billing issues, and maintaining accurate records.

Key Responsibilities
  • Claims Processing: Accurately and timely process electronic and hardcopy medical claims, ensuring compliance with regulatory requirements.
  • Billing and Payment Management: Input billings and post payments/deposits into accounting software, maintaining accurate records and resolving any discrepancies.
  • Denial and Collection: Research and resolve denied billings, taking action to collect outstanding payments and communicate with internal and external representatives as needed.
  • Trend Analysis: Identify trends in billing and payment issues, communicating findings to supervisors and implementing solutions to improve efficiency.
  • Record Keeping: Maintain accurate and up-to-date billing and payment records, adhering to contract requirements.
  • Communication: Effectively communicate with internal and external representatives to facilitate billing issue resolution and build strong working relationships.
  • Special Projects: Assist with managing special projects as needed, including policy and procedure documentation.
  • Account Activity: Document all account activity and respond to inquiries in a timely manner.
Requirements
  • Education: High School diploma or equivalent.
  • Experience: Must have experience in accounts receivable and prior authorizations.
  • Skills: Excellent organizational and time management skills, strict attention to detail, and proficiency in MAC, Google Drive, and Advanced MD.
  • Qualifications: A high standard of integrity and sound business ethics, ability to work effectively with other internal and external departments, and ability to work independently and as a team player.
Benefits
  • Medical, Dental, and Vision Insurance: Comprehensive health insurance package.
  • 401(k) Retirement Plan: Employer-matched retirement savings plan.
  • Paid Time Off: Generous paid time off benefits, including vacation, holiday, and sick leave.
  • Parental Leave: Support for new parents.
Work Environment
  • Office Setting: Work in a professional office environment.
  • Schedule: 8-hour shift, Monday to Friday.
Experience
  • Accounts Receivable: Experience in accounts receivable and prior authorizations.


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