Medical Claims Specialist
4 days ago
Job Summary: FemmPro OB/GYN is seeking a highly motivated and detail-oriented individual to join our team as a Medical Claims Specialist. In this role, you will be responsible for researching and resolving claims, contacting payers, and managing remittance and correspondence.
Key Responsibilities:
- Proactively research and resolve claims based on assignment.
- Contact payers via phone or website, write appeals, and facilitate their direction for submission.
- Handle re-credentialing whenever required by insurance companies.
- Manage and resolve unpostables, manage remittance, and all correspondence in each of the dashboards daily.
- Manage and resolve Zero-Pay Worklist, Unpaid claims, Fully Worked Receivables, Review and respond to adjustments/payment data with approval (or initiate appeal) communicate trends and root issues through proper lines of reporting.
- Illustrate excellent knowledge of healthcare industry regarding the revenue cycle, coding, claims, and state insurance laws.
- Keep management informed of correspondence and communication problems.
- Educate and communicate revenue cycle/financial information to patients, payers, co-workers, managers, and others as necessary to ensure accurate processes.
Qualifications:
- Minimum of 3 years of experience as a Biller, Collector, Coder, or back-office support staff OR a minimum of 1 year in an OB/GYN setting.
- Excellent written and oral communication skills.
- Advanced knowledge of EHRs, Availity, and insurance portals.
- Advanced knowledge of Microsoft Office.
- Strong organizational, problem-solving, and decision-making skills.
- Ability to prioritize and manage multiple projects and issues effectively and simultaneously.
- Results-Oriented, Self-Motivated, and Self-Starter who can work well under minimal supervision.
- Strong attention to detail, research, and follow-up skills.
Benefits:
- Competitive pay commensurate with experience.
- Comprehensive benefits package, including medical, dental, and vision insurance.
- 401k plan (Traditional and Roth) with 3% automatic employer contribution and discretionary profit-sharing.
- Paid time off and holiday pay.
- Continuing education reimbursement where applicable and professional development opportunities.
- Supportive work environment focused on patient-centered care.
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