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Healthcare Claims Specialist

2 months ago

Bridgeton, Missouri, United States AT Home Care Full time

Become a Vital Part of Our Team

  • EXPERIENCED BILLING PROFESSIONAL REQUIRED: We are looking for a dedicated individual with a minimum of 1 year of experience in home care or home health care billing.

At AT Home Care, we value our team members and offer:

    • Comprehensive Medical, Vision, Dental, and Life Insurance
    • Weekly Compensation with Direct Deposit
    • Competitive Pay Scale
    • Paid Time Off and Holiday Compensation
    • Reimbursement for Travel Expenses

Position Overview: The Healthcare Claims Specialist, under general supervision, is responsible for all aspects of preparing and submitting medical insurance claims. This role involves reviewing and adjusting accounts to ensure accurate billing, engaging with third parties and participants, processing, researching, correcting accounts, posting payments and adjustments, and interpreting Explanation of Benefits (EOB) documentation. The ideal candidate will demonstrate sound judgment in various situations, possess strong written and verbal communication skills, and exhibit excellent organizational abilities while managing multiple priorities.

Key Responsibilities:

  • Prepare and submit accurate claims to various insurance providers electronically through EMOMED or the payer portal.
  • Process medical claims via a billing clearinghouse or traditional paper methods.
  • Collect insurance billing information by reviewing patient hospital records for completeness.
  • Input billing information into the database and initiate electronic transmissions to carriers.
  • Manage claims as they are paid and appropriately credit accounts.
  • Resolve disputed claims by gathering, verifying, and providing additional information, as well as following up on claims.
  • Address discrepancies by examining and evaluating data, selecting corrective actions as necessary.
  • Adjust patient bills by reviewing remittance advice and consulting with payers.
  • Monitor payer claim acceptance and response times.
  • Contact payers when necessary to obtain updates on claim payments.
  • Correct and resubmit denied claims.
  • Escalate claims for potential bulk resolution with payer relations.
  • Ensure accurate charge capture, billing, and adjudication of claims in accordance with federal, state, and private billing guidelines.

Qualifications:

  • Minimum of 1 year of experience in Healthcare Missouri Medicaid medical claims processing or billing.
  • Ability to effectively manage workload in a high-volume setting with strong attention to detail.
  • Proficient in PC applications, including Microsoft Office Suite (Excel, Word).
  • Strong aptitude for computing percentages and basic mathematical functions.
  • Excellent oral, written, and interpersonal communication skills.