Medical Claims Specialist

1 month ago


Goodyear, Arizona, United States Leading Healthcare Clinic of Goodyear Full time
Job Summary

We are seeking a highly skilled Medical Claims Specialist to join our team at the Leading Healthcare Clinic of Goodyear. The ideal candidate will have a strong background in medical billing and insurance claims processing.

Key Responsibilities:

  • Timely submission of medical claims to insurance companies
  • Following up on unpaid claims within the standard billing cycle timeframe
  • Checking each insurance payment for accuracy and compliance with contract discount
  • Identifying and billing secondary or tertiary insurances
  • Reviewing accounts for insurance of patient follow-up
  • Researching and appealing denied claims
  • Answering all patient or insurance telephone inquiries pertaining to assigned accounts
  • Setting up patient payment plans and work collection accounts
  • Reviewing patient bills for accuracy and completeness and obtaining any missing information
  • Identifying trends of denials and presenting solutions for the issue

Requirements:

  • Knowledge of HCFA-1500 paper claim forms and 837 electronic equivalent
  • Knowledge of insurance eligibility and benefits (deductible, copay, co-insurance)
  • Knowledge of reading insurance company Explanation of Benefits and understanding rejections/denials and what to do to correct them
  • Positive, driven attitude with a willingness to go the extra mile to help patients and to help the office achieve financial and operational success

Qualifications:

  • Graduate of accredited high school or GED required
  • Minimum of two years of experience in health-related billing, accounts receivable and collections
  • Proficiency with Excel and Word
  • 1+ year experience with electronic medical/health record preferred

Work Environment:

Remote work available



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