Medical Claims Specialist

3 weeks ago


Dallas, Texas, United States Parkland Health and Hospital System (PHHS) Full time

Job Summary

Parkland Health and Hospital System (PHHS) seeks a skilled Medical Claims Specialist to join our team. As a key member of our revenue cycle team, you will be responsible for resolving outstanding balances and securing accurate and timely payments from third-party payors.

Key Responsibilities

  • Resolve outstanding claims for assigned accounts by verifying reason for non-payment and correcting account information.
  • Submit appeals, correct account information, coordinate requests for medical records, and post account adjustments to resolve account balances promptly.
  • Document all actions taken on accounts in the system account notes to ensure all prior actions are noted and understandable by others.
  • Perform routine audits of individual accounts to resolve all discrepancies in account balances.
  • Maintain a positive working relationship with contacts at all agencies, patients, insurance companies, government entities, clinical personnel, other Parkland staff, and management to promote teamwork, cooperation, and a positive public image for Parkland.

Requirements

  • Three years of experience in a hospital business office, physician business office, or insurance company, including two years of experience in medical billing and/or collecting from third-party payors.
  • Certification/Registration/Licensure.
  • Ability to demonstrate a working knowledge of personal computers and other standard office equipment.
  • Ability to exercise good judgment in handling government and/or nongovernment accounts and understand managed care and insurance contractual arrangements.
  • Working knowledge of medical software.
  • Detail-oriented, possess basic mathematical skills, and have sharp analytical skills to resolve financial issues as they relate to multiple groups including third-party payors, physicians, patients, and the system.
  • Ability to handle potentially stressful situations and multiple tasks simultaneously.
  • Ability to communicate effectively with patients, families, government entities, insurance companies, and Parkland staff.
  • Ability to solve problems within the guidelines of established policies and procedures.
  • Basic medical terminology knowledge preferred.
  • Bilingual skills preferred.

About Parkland Health and Hospital System (PHHS)

Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.



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