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Claims Processing Specialist in Medical Billing
2 months ago
A leading full-service dermatology practice is seeking a skilled candidate for the role of Claims Processing Specialist focused on insurance claims management and payment posting. The ideal candidate will possess a dynamic personality, integrity, a quick learning ability, and strong multitasking skills. Interested applicants should provide a cover letter along with their latest resume.
Qualifications and Experience:
- High school diploma or equivalent.
- Completion of an accredited medical billing program (applications from candidates without a medical billing and coding certification will not be considered).
- A minimum of three years of experience in a medical environment.
- Typing proficiency of at least 40 words per minute.
- Must be fully vaccinated against COVID-19, including the booster.
- Valid California Driver's License with a clean driving record.
Compensation: Based on experience.
Key Skills and Competencies:
- Familiarity with CPT and ICD coding systems.
- Understanding of basic accounting principles and practices.
- Ability to follow established instructions and guidelines.
- Works under direct supervision.
- Professional demeanor with strong interpersonal, grammatical, and communication skills.
- Well-groomed appearance and conduct.
- Capacity to handle multiple responsibilities simultaneously.
- Ability to interact effectively with diverse individuals at all levels of the organization.
- Detail-oriented with a commitment to high standards of excellence.
- Team-oriented mindset.
- Strong organizational skills.
- Proficient in computer applications.
- Minimum typing speed of 45 words per minute.
Primary Responsibilities:
- Compile and submit insurance claims based on data provided by healthcare professionals.
- Utilize coded information to generate and send claims to insurance providers.
- Engage directly with insurance companies, healthcare providers, and patients to facilitate claim processing and payment.
- Review and appeal unpaid or denied claims.
- Verify patient insurance coverage.
- Address billing inquiries from patients.
- Translate medical diagnoses and procedures into standardized coding for billing purposes.
- Ensure compliance with HIPAA regulations and guidelines set by the Office of Inspector General.
- Expedite the claims process to ensure timely reimbursement for services rendered.
- File and submit claims electronically.
- Cross-check that all procedures on claims match those on the statements received from insurers.
- Review payments for accuracy.
- Initiate appeals for discrepancies on behalf of the healthcare provider.
- Accurately post all Medicare EFT Insurance payments and write-offs as per patient insurance plans.
- Balance daily transactions and prepare deposits.
- Secure payments until they are posted.
- Generate necessary financial reports.
- Record all charges daily.
- Be prepared to assist with other duties as needed.
Insurance Claim Preparation:
- Ensure procedure and diagnosis codes accurately represent services provided.
- Generate weekly insurance claims and maintain a Pending Claims Report for outstanding claims over 30-45 days.
- Process billing transactions to maintain accuracy and efficiency.
- Respond to billing inquiries from patients, medical offices, and insurers.
- Prepare and submit claims using both electronic and paper methods as necessary.
- Process payments from insurers and patients, including daily batch postings.
- Identify and resolve billing discrepancies.
- Conduct collections actions, including contacting patients and resubmitting claims.
- Manage accounts receivable as assigned.
- Correct rejections from clearinghouses.
- Assist with month-end financial processes.
- Ensure compliance with financial policies and procedures.
- Perform additional tasks as assigned.
- Utilize specific software for daily operations, with access subject to change.
Desired Attributes:
- Strong organizational, analytical, and problem-solving skills; capable of managing priorities and workflow.
- Professional demeanor with excellent interpersonal and communication skills.
- Ability to handle sensitive information with discretion and integrity.
- Creative and adaptable to fast-paced environments.
- Integrity and a strong work ethic.
- Effective communication skills with a positive attitude.
- Passionate about personal and organizational success.
- Ability to work independently and collaboratively.
- Attention to detail and ability to meet deadlines in a dynamic environment.
Behavioral Standards:
We uphold the following standards of behavior to foster an optimal workplace environment:
- Exceptional customer service.
- Professionalism in all interactions.
- Respectful communication with all stakeholders.
- Effective teamwork.
- Commitment to a safe work environment.
- Positive attitude and a sense of humor.
- Supportive of colleagues and the practice.
Principals only. Recruiters, please refrain from contacting this job poster.
Unsolicited services or offers will not be entertained.
