Medical Claims Specialist

4 days ago


Houston, Texas, United States St. Josephs Medical Center Full time

Company Overview:

St. Joseph Medical Center is a world-class healthcare provider, dedicated to delivering exceptional care to the community of Houston for over 137 years.

We pride ourselves on our tradition of compassion and innovation, ensuring that every patient receives personalized attention and top-notch treatment.

About the Role:

This exciting opportunity is available in our revenue cycle team, where you will play a vital role in ensuring the accuracy of our accounts receivable and resolving credit balance issues efficiently.

Responsibilities:

  • You will be responsible for following up with patients and insurance carriers regarding outstanding balances
  • Contacting insurance companies to resolve payment disputes and negotiate settlements
  • Resubmitting claims with necessary remarks and attachments
  • Validating accounts for accurate payments, discounts, and contractual adjustments
  • Replying to insurance carrier correspondence and ensuring timely resolution of patient issues
  • Running insurance eligibility checks and correcting claims as needed
  • Pulling supporting documents for regulatory audits, as required
  • Ensuring timely review and resolution of credit balance and refund requests
  • Providing excellent customer service by responding to incoming calls and resolving patient concerns efficiently

Requirements:

  • A minimum of one year's experience in commercial, HMO, PPO, and workers' compensation billing or insurance follow-up
  • A working knowledge of HMO, PPO, commercial, and workers' compensation reimbursement
  • A working knowledge of managed care contract language and interpretation

What We Offer:

As a valued member of our team, you can expect a competitive salary range of $43,000-$65,000 per annum, depending on your level of experience and qualifications.

At St. Joseph Medical Center, we strive to create a work environment that promotes diversity, equity, inclusion, and belonging. We are an equal opportunities employer and welcome applications from candidates who share our values.



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