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Medical Claims Specialist

1 month ago


Wilmington, North Carolina, United States Wilmington Health Full time
Job Title: Medical Claims Specialist

Wilmington Health is seeking a Medical Claims Specialist to join our team. As a Medical Claims Specialist, you will be responsible for ensuring prompt collection of the appropriate amount due.

Key Responsibilities:

  • Follow-up with carriers regarding outstanding claims as noted on the outstanding invoice report
  • File claims that require additional documentation
  • Verify benefits as requested by physicians
  • Change insurance information as appropriate
  • Correspond with carriers for appeals and inquiries
  • Communicate insurance regulation changes to supervisors
  • Contact patients and carriers to follow-up on denials and termination of coverage
  • Respond to telephone calls and review and respond to correspondence
  • Process computer refunds due to patients and insurance companies
  • Establish payment plans
  • Define relationship issues and act as an advocate for referring providers and office staff to cross-functionally resolve outstanding issues with WH and ensure satisfactory resolutions and referral processes
  • Work collaboratively with occupational health and corporate wellness to establish integrated strategic business plans to achieve corporate objectives for products and services

Qualifications:

  • High school diploma or general education degree (GED)
  • 3-5 years' experience in a medical office environment
  • or equivalent combination of education and experience
  • Full COVID-19 vaccination is required as a condition of employment for all positions with Wilmington Health. Documentation is required prior to orientation.

Preferred Qualifications:

  • Experience in Medical Office Administration
  • Knowledge of OSHA and DOT regulations
  • Experience with urine drug screen collection and breath alcohol tests processes
  • BLS/CPR Certified

Wilmington Health is an Equal Opportunity Employer committed to providing equal opportunities to all applicants and employees. We are committed to treating everyone equally and with respect regardless of race, age, sex, religion, national origin, citizenship, marital status, veteran's status, sexual preference, disability, genetic information, or any other class protected under state or federal law.