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Medical Claims Processor

2 months ago

Downers Grove, Illinois, United States ambercare Full time
Job Summary

We are seeking a highly skilled Reimbursement Specialist to join our team at Ambercare. The successful candidate will be responsible for managing the reimbursement process, ensuring accurate and timely payment of medical claims.

Key Responsibilities
  • Medical Claims Processing: Accurately interpret patient insurance, prescription, and other health-related documentation to ensure compliance with regulatory requirements.
  • Insurance Verification: Conduct thorough insurance verifications and investigations for commercial and government payors to ensure accurate reimbursement.
  • Reimbursement Coordination: Communicate with insurance companies, patients, providers, and prescribers to coordinate reimbursement and access solutions.
  • Unpaid Accounts Management: Review unpaid accounts to determine status and take appropriate action to ensure payment.
  • Claims Compliance: Review all claims for compliance and completeness for claims submissions.
  • Alternative Funding Research: Research available alternative funding options to reduce patient financial burden.
  • High-Volume Call Handling: Handle high call volumes with professionalism and efficiency.
  • Interdepartmental Coordination: Communicate with internal and external departments to facilitate coordination of care.
  • Confidentiality and Attendance: Maintain a high degree of confidentiality at all times due to access to sensitive information and maintain regular, predictable, consistent attendance.
  • Regulatory Compliance: Follow all Medicare, Medicaid, and HIPAA regulations and requirements.
Requirements
  • Education: High school diploma or equivalent required; undergraduate degree preferred.
  • Experience: Experience in medical billing, accounts receivables, and/or collections within a healthcare or insurance environment preferred.
  • Technical Skills: Possess quick and accurate Alpha/numeric data entry skills and computer proficiency in MS Office and Web-enabled applications.
  • Regulatory Knowledge: Understanding of the requirements of Medicaid, Medicare, and insurance billing preferred.
  • Customer Service: Maintain positive internal and external customer service relationships.