Medical Claims Specialist

3 weeks ago


Lawrenceville, Georgia, United States National Vision Full time
Job Title: Medical Claims Specialist

Job Summary:
National Vision is seeking a Medical Claims Specialist to join our team. As a Medical Claims Specialist, you will be responsible for submitting, editing, correcting, and researching claims to ensure clean adjudication payment from all payors.

Key Responsibilities:

* Prepares and generates clean claims for submission to all payor types, including third party payors, Medicare and Medicaid.
* Processes an average of 20-25 claims per hour.
* Facilitates all rejections from electronic or paper claims. Obtains information from carriers, stores, internal entities or patients when services billed are denied for reasons such as incorrect insurance information, demographic information and/or authorization.
* Develops and maintains working relationships with internal/external providers to ensure billings and collections procedures are current.
* Researches and resolves all zero payment explanations or benefits and exercises all options to obtain claims payments; initiates adjustments as necessary.

Requirements:

* 2-4 years related experience and/or training or equivalent combination of education and experience.
* High school, plus specialized schooling and/or on the job education in a specific skill area; E.G. data processing, clerical/administrative, equipment operation, etc.
* POS System experience preferred.
* Knowledge of CPT-4, ICD0, HCPCS, Medicare/Medical Terminology required.

What We Offer:

* Competitive compensation package.
* Comprehensive benefits package including health and dental insurance, 401k retirement savings with company match, flex spending account, paid personal time off, paid company holidays, parental leave, employee eyewear discount and much more.
* Opportunities for professional growth and long-term career fulfillment.
* Training programs, access to educational courses and a culture that values and respects individual differences.

Equal Opportunity Employer:

National Vision is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, genetic information, disability, veteran status, and other legally protected characteristics.

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