Medical Claims Specialist

2 days ago


Austin, Texas, United States Advanced Pain Care Full time
Job Summary

The Appeals Specialist is responsible for managing insurance denials by reviewing claims and clinical documentation, posting payments, handling correspondence letters and writing appeals to correct payment amount and/or non-payment.

Key Responsibilities
  • Reviews and appeals unpaid and denied claims
  • Attaches appropriate documents to appeal letters
  • Researches and evaluates insurance payments and correspondence for accuracy
  • Logs appeals and grievances, and tracks progress of claims
  • Keeps up-to-date reports and notates any trends pertaining to insurance denials
  • Calls insurance companies to inquire about claims, refund requests and payments
  • Manages Accounts Receivable reports for the Billing Department
  • Utilizes EMR system to submit and correct claims
  • Posts patient and insurance payments
  • Sends paper claims to insurance carriers
  • Answers patient billing questions
  • Coordinates medical and billing records payments with patients and/or third-party payers
  • Handles collections on unpaid accounts
  • Identifies and resolves patient billing complaints
  • Answers phone calls to the Billing Department in a timely and professional manner
  • Processes credit card payments over the phone and in person
  • Serves and protects the practice by adhering to professional standards, policies and procedures, federal, state, and local requirements
  • Enhances practice reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments
  • Operates standard office equipment (e.g. copier, personal computer, fax, etc.)
  • Has regular and predictable attendance
  • Adheres to Advanced Pain Care's Policies and procedures
  • Performs other duties as assigned
Requirements
  • Qualifications: Requires a high school diploma or GED
  • Experience: Three or more years related work experience of training
  • Knowledge, Skills and Abilities:
    • Clear and precise communication
    • Ability to pay close attention to detail
    • Effectively manages day by organizing and prioritizing
    • Possesses excellent phone and customer service skills and abilities
    • Protects patient information and maintains confidentiality
    • Knowledge of general medical terminology, CPT, ICD-9 and ICD-10 coding
    • Familiarity with analyzing electronic remittance advice and electronic fund transfers
    • Experience interpreting zero pays and insurance denials
    • Competence in answering patient questions and concerns about billing statements
    • Organizational skills and ability to identify, analyze and solve problems
    • Works well independently as well as with a team
    • Strong written and verbal communication skills
    • Interpersonal/human relations skills
Working Conditions

Medical Office environment

Must be able to work as scheduled - typically from 8:00 - 5:00 M-F

Must be able to sit and/or stand for prolonged periods of time

Must be able to bend, stoop and stretch

Must be able to lift and move boxes and other items weighing up to 30 pounds.

Requires eye-hand coordination and manual dexterity sufficient to operate office equipment, etc.



  • Austin, Texas, United States Aveanna Healthcare LLC Full time

    Job Title: Medical Insurance Collections SpecialistAveanna Healthcare LLC is seeking a highly skilled Medical Insurance Collections Specialist to join our team. The successful candidate will be responsible for following up with unpaid invoices, researching denials, and converting them to ensure timely payment.Key Responsibilities:Follow up with payers to...


  • Austin, Texas, United States Complete Staffing Solutions Full time

    Job Title: Medical Claims Analyst/Workers CompAt Complete Staffing Solutions, we are seeking a highly skilled Medical Claims Analyst/Workers Comp to join our team. As a Medical Claims Analyst/Workers Comp, you will be responsible for providing expert analysis and resolution of medical claims, ensuring timely and accurate processing of claims, and providing...


  • Austin, Texas, United States Tesla Full time

    Auto Claims SpecialistAt Tesla, we're looking for a skilled Auto Claims Specialist to join our team. As a key member of our claims department, you'll be responsible for handling moderate exposure insurance claims with compassion and effectiveness.Key Responsibilities:Analyze and interpret policies to assess coverage and liabilityHandle moderate to high...


  • Austin, Texas, United States Advanced Pain Care Full time

    Job Title: Appeals SpecialistJoin Advanced Pain Care as an Appeals Specialist and play a vital role in managing insurance denials and ensuring accurate payments for our patients.Job Summary:The Appeals Specialist is responsible for reviewing claims and clinical documentation, posting payments, handling correspondence letters, and writing appeals to correct...


  • Austin, Texas, United States Southwest Dermatology & Vein Full time

    Join our dynamic Dermatology practice in South Austin, Texas as a full-time Insurance Claims Specialist, focusing on Medical Billing and Accounts Receivable. Key Responsibilities: Manage claim rejections and denials, submitting corrected claims and appeals as necessary.Prepare and submit electronic claims efficiently.Stay informed on the latest CPT, ICD, and...


  • Austin, Texas, United States Texas Municipal League Intergovernmental Risk Pool Full time

    The Texas Municipal League Intergovernmental Risk Pool is seeking a skilled Workers' Compensation Claims Assistant to join our team in Austin, Texas. As a key member of our risk management team, you will be responsible for processing new claims, verifying claim information, and entering data into our computerized database. Your excellent communication skills...


  • Austin, Texas, United States Texas Municipal League Intergovernmental Risk Pool Full time

    Job SummaryWe are seeking a highly organized and detail-oriented Workers' Compensation Claims Assistant to join our team at the Texas Municipal League Intergovernmental Risk Pool. As a key member of our department, you will provide clerical and customer service support for our operations, ensuring seamless communication and efficient processing of claims.Key...

  • Claims Specialist

    3 days ago


    Austin, Texas, United States SNI Companies Full time

    Claims Customer Support RepresentativeSNI Companies is seeking a highly skilled Claims Customer Support Representative to join our team. As a Claims Customer Support Representative, you will be responsible for processing and adjudicating automotive related claims in a professional environment.Key Responsibilities:Process and adjudicate automotive related...


  • Austin, Texas, United States Texas Association of School Boards Full time

    Job DescriptionWe are seeking a highly skilled Medical Claims Examiner II to join our team at the Texas Association of School Boards. As a Medical Claims Examiner II, you will be responsible for investigating and evaluating medical only claims in a timely manner, per Texas WC statutes and guidelines.Key Responsibilities:Investigate and evaluate all assigned...

  • Claims Specialist

    3 weeks ago


    Austin, Texas, United States SNI Companies Full time

    Claims Customer Support RepresentativeSNI Companies is seeking a highly skilled Claims Customer Support Representative to join our team. As a Claims Customer Support Representative, you will be responsible for processing and adjudicating automotive related claims in a professional environment.Key Responsibilities:Process and adjudicate automotive related...


  • Austin, Texas, United States Skybeck Construction Full time

    {"title": "Warranty Specialist", "description": "Job Summary:Skybeck Construction is seeking a skilled Warranty Specialist to oversee the completion of warranty claims and ensure timely repairs meet our high standards for quality and customer satisfaction.This role requires a detail-oriented individual who can execute tasks with precision and attention to...


  • Austin, Texas, United States CompuGroup Medical Full time

    Join Our Team as a Medical Billing Administrative SpecialistCreate the future of e-health with CompuGroup Medical by becoming a Medical Billing Administrative Specialist. Our mission is to build innovative solutions for digital healthcare, and our vision is to revolutionize how healthcare professionals access and utilize information.Your Key...


  • Austin, Texas, United States Skybeck Construction Full time

    Skybeck Construction is a leading provider of multifamily construction services, seeking a skilled Warranty Specialist to join our team.This is an exciting opportunity for a detail-oriented individual to oversee warranty claims, ensure timely repairs, and deliver exceptional customer satisfaction.Key Responsibilities:• Execute advanced carpentry skills to...


  • Austin, Texas, United States Southwest Dermatology & Vein Full time

    Medical Biller - Insurance A/R SpecialistSouthwest Dermatology & Vein is seeking a highly skilled Medical Biller - Insurance A/R Specialist to join our team. As a key member of our revenue cycle team, you will be responsible for ensuring accurate and timely processing of medical claims, managing denials and appeals, and maintaining compliance with regulatory...


  • Austin, Texas, United States Texas Medical Association Full time

    Job SummaryWe are seeking a highly skilled and detail-oriented Medical Coding Specialist to join our team at the Texas Medical Association. This role will play a critical part in ensuring that physicians and their staff are well-informed about coding, billing, and payment issues that impact the viability of their practices.Key ResponsibilitiesMonitor...


  • Austin, Texas, United States Tesla Full time

    {"Responsibilities": "Key ResponsibilitiesAnalyze and interpret policies to assess coverage and liability.Handle moderate to high complexity claims, including contributory and comparative negligence, multi-vehicle losses with complex liability, and complex coverage investigations.Establish and maintain proper loss and expense reserves on all managed...


  • Austin, Texas, United States STATE OFFICE OF RISK MANAGEMENT Full time

    Job SummaryThe State Office of Risk Management is seeking an experienced Claims Adjuster or Insurance Adjuster to join our team. As a Claims Adjuster, you will be responsible for investigating, analyzing, and paying benefits in accordance with the Texas Workers' Compensation Act and Rules.Key ResponsibilitiesReview and determine compensability of workers'...


  • Austin, Texas, United States Southwest Dermatology & Vein Full time

    Medical Biller - Insurance A/R SpecialistSouthwest Dermatology & Vein is seeking a highly skilled Medical Biller to join our team. As a Medical Biller, you will play a crucial role in ensuring the smooth operation of our revenue cycle.Responsibilities:Work with rejects and denials, sending corrected claims and appealsBuild and submit electronic claimsStay...


  • Austin, Texas, United States Ascension Full time

    Job SummaryWe are seeking a highly skilled Medical Billing Specialist to join our team at Ascension Seton. As a Medical Billing Specialist, you will be responsible for determining and verifying insurance coverage and coordination of benefits from all sources for assigned areas. You will ensure proper, adequate, and timely billing to ensure prompt...

  • Claims Administrator

    3 weeks ago


    Austin, Texas, United States Service Insurance Companies Full time

    Job SummaryWe are seeking a highly organized and detail-oriented Claims Processor to join our team at Service Insurance Companies. As a Claims Processor, you will play a critical role in supporting our claims team by providing administrative support and ensuring timely and accurate processing of claims.Key ResponsibilitiesProcess and manage claims from...