Medical Claims Specialist

4 days ago


Cincinnati, Ohio, United States OrthoAlliance Full time
Job Summary

We are seeking a highly skilled Medical Claims Specialist to join our team at OrthoAlliance. As a key member of our claims processing team, you will be responsible for ensuring timely and accurate submission of claims to maintain the highest quality of service and timely payment.

Key Responsibilities
  • Assure timely and accurate submission of claims to maintain the highest quality of service and timely payment.
  • Submits all paper claims and supporting documentation as required by payers.
  • Reports any errors trends/delays to supervisor.
  • Researches and resolves any electronic claim delays within 24 hours.
  • Correction of clearinghouse errors.
  • Participates in continuing educational activities relative to assigned duties and responsibilities.
Requirements
  • High school graduate or equivalent.
  • Medical Billing Experience including CPT and ICD10.
  • Medical Accounts Receivable, Denial Management, or Clearinghouse Rejection Experience.
  • Experience with electronic health records/practice management system.
  • NextGen PM and NextGen EHR.
  • Waystar experience preferred.
  • Understanding of major insurance carriers including, HMOs, PPOs and governmental payers.
  • Proficiency in Explanation of Benefits (EOB) methodologies and principles.
  • Sound judgment, maturity, and an ability to establish good rapport with patients, public, and staff.
  • Proficiency with Microsoft Teams, Outlook, and Excel.
Work Environment

The position is located inside with moderate noise level, good lighting and even requirements for the position include the ability to frequently hear and communicate orally, see up close and at a distance, read and comprehend, stand, sit, walk, reach, handle, and/or feel objects. Maximum unassisted lift = 25 lbs. Average lift less than 10 lbs.



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