Medical Claims Specialist

4 weeks 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.

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