Medical Claims Specialist

4 weeks ago


Scarborough, Maine, United States New England Life Care Full time

New England Life Care is a leading home infusion therapy provider in New England, dedicated to delivering exceptional patient care and quality service.

The company was created by local hospitals to ensure their patients have access to a provider that reflects their commitment to excellence in patient care, quality, and service.

New England Life Care has built a diverse, inclusive, and authentic workplace, where talented individuals can thrive and grow in their careers.

We are seeking a skilled Hybrid Biller to join our team, responsible for the billing of insurances and patients.

The normal schedule for this position is Monday - Friday from 8:00am until 4:30pm, with the requirement to be onsite 2-3 days each week.

Job Summary:

The biller is responsible for achieving performance appraisals with 'meets expectations' or better, demonstrating independence and competence in reviewing and navigating patient accounts and delivery tickets, creating and accepting claims from clearing houses, and working claim rejections.

Responsibilities:

  • Achieve performance appraisals with 'meets expectations' or better
  • Demonstrate independence and competence in reviewing and navigating patient accounts and delivery tickets
  • Demonstrate independence and competence in creating and accepting claims from clearing houses and working claim rejections
  • Demonstrate independence and competence in working daily billing reports
  • Demonstrate independence and competence in teaching basic billing knowledge, splitting claims, recognizing billing and account errors, working To Do's, and sending out daily goal emails
  • Demonstrate independence and competence in billing 20 or more clean claims a day
  • Demonstrate independence and competence in billing using payor sheets
  • Demonstrate independence and competence in teaching how to navigate through patient accounts and delivery tickets
  • Maintain an average of 95% or better in claim audits
  • All billing queues reviewed weekly
  • Billing rejections worked daily from queue
  • To Do's completed within 2 days

Education:

A 3-year experience in a healthcare setting processing healthcare provider claims or comparative experience in a healthcare setting is required. A working knowledge of government health insurance plan benefits and the rules & regulations for obtaining reimbursement is also required.

Required Qualifications:

  • 1 year experience in a healthcare setting processing healthcare provider claims or comparative experience in a healthcare setting
  • A working knowledge of government health insurance plan benefits and the rules & regulations for obtaining reimbursement
  • Knowledge of HIPAA Privacy and Security requirements
  • Working knowledge of federal / state fraud and abuse laws
  • Demonstrated knowledge of medical terminology; CPT; ICD9; and HCPC coding
  • Excellent customer service skills
  • Excellent communications skills
  • Excellent organizational skills
  • Ability to work independently as well as part of a team
  • Practical experience with microcomputer systems and applications to include Microsoft Word and Excel
  • Demonstrated ability to identify research and solve problems

Preferred Qualifications:

  • Associate degree
  • Demonstrated knowledge of medical terminology; CPT; ICD9; and HCPC coding
  • Excellent customer service skills
  • Excellent communications skills
  • Excellent organizational skills
  • Ability to work independently as well as part of a team
  • Practical experience with microcomputer systems and applications to include Microsoft Word and Excel
  • Demonstrated ability to identify research and solve problems

Benefits:

New England Life Care offers a range of benefits, including career ladder opportunities, health insurance, dental insurance, vision insurance, a generous employer-matched 403b savings program, life insurance, short- and long-term disability insurance, paid time off, and much more.



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