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Medical Claims Specialist
3 weeks ago
At Balance Health, we are seeking an experienced Medical Claims Specialist to join our team. This role is responsible for reviewing claims activity for billing and submitting claims in the revenue cycle billing and claims functions.
The ideal candidate will have a minimum of 3 years' experience interpreting insurance explanation of benefits, with at least 3 years' experience in medical claims, billing, payment posting, and insurance collections.
Key Responsibilities:
- Follow up on rejected and/or unpaid claims according to established standards.
- Work with MGRHOLD and HOLD Buckets as required by productivity measures.
- Review and appeal unpaid and denied claims.
- Determine accuracy of Insurance Payments and follow up on discrepancies.
- Run and build reports as required and/or requested.
- Properly monitor A/R and collections.
Requirements:
- Bachelor's degree or equivalent experience.
- Ability to use independent judgment and manage confidential information.
- Knowledge of legal, regulatory, and policy compliance issues related to medical coding and billing procedures and documentation.
Salary: $65,000 - $85,000 per year, depending on experience level. Benefits include competitive hourly pay rate, benefit eligibility after 30 days of employment, and participation in our 401(k) program after 60 days of employment.