Medical Claims Specialist

5 days ago


Richmond, Virginia, United States Richmond Behavioral Health Authority Full time
Job Summary

We are seeking a highly detail-oriented and organized Medical Claims Specialist to join our team at Richmond Behavioral Health Authority. As a Medical Claims Specialist, you will be responsible for the timely and accurate submission of medical and behavioral health claims, as well as evaluating payments received and applied to patient accounts.

Key Responsibilities
  • Claims Submission: Submit timely and accurate claims to payors for all services provided, ensuring a good understanding of the terms and fee schedule for all contracts.
  • Payment Evaluation: Evaluate payments received for correctness and applied accurately in our billing system, verifying payments received are correct according to the fee schedule.
  • Follow-up and Resolution: Follow up on claims submitted to ensure prompt and timely payment, calling to verify that claims submitted were received and are in processing, and sending letters to the patient or responsible party when their insurance carrier fails to make payment.
  • Compliance and Confidentiality: Ensure compliance with policies and guidelines outlined in the contract terms and fee schedule, and follow HIPPA guidelines when accessing and sharing patient information to maintain patient and business confidentiality.
Requirements
  • Basic Qualifications: Basic level skill in Microsoft Excel and Microsoft Word, High School Diploma or equivalent, and 1-3 years medical reimbursement and billing experience.
About Us

Richmond Behavioral Health Authority is a licensed public entity responsible for providing mental health, intellectual disabilities, substance abuse, and prevention services to the citizens of the City of Richmond. Our mission is to promote health, wellness, and recovery for the people and communities we serve.



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