Medical Claim Specialist
Found in: Talent US C2 - 2 weeks ago
Job Summary
Responsible for collecting accounts receivables on patient accounts, non-government
and contracted insurances government payers and secondary billing. Responsibilities include routine follow-up on accounts, working the Rejection Report for contracted insurances, analyzing aged trial balance report for assigned chargeto’s, working the Antrim, Rhodes reports and miscellaneous accounts receivable reports.
ESSENTIAL FUNCTIONS:
1. Collects outstanding accounts receivables on patient accounts from patient, commercial, non-government, contracted insurances or government payors via phone call to the patient or insurance company or by means of written appeal or reconsideration.
2. Pursues collection activities on assigned accounts from primary and secondary payors until worked to resolution to include claims resubmission, appeal or reconsideration.
3. Works account receivables reports (i.e. aged-trial-balance report), focusing attention on accounts over 60 days.
4. Researches adjustments and pull all necessary backup to support adjustments.
5. Utilizes on-line insurance resources to obtain and maintain current information.
6. Develops and maintains a professional working rapport with internal and external customers to include contacts with insurance company representatives.
7. Identifies trends in payment or non-payment of claims. Communicates findings to leadership and co-workers as appropriate.
8. Customizes reports in Antrim and or Excel to prioritize accounts for collecting.
The above statements describe the general nature and level of work being performed by individuals assigned to this classification. This is not intended to be an exhaustive list of all responsibilities and duties required of personnel so classified.
Minimum Qualifications
MINIMUM EDUCATION:
• High school diploma or equivalent
MINIMUM EXPERIENCE:
Must have one of the following:
• Six (6) months as an Apprentice in the Business Office at TriCore
• Minimum of one (1) year of laboratory or medical claims follow-up/collections
experience
• Minimum of three (3) years of medical billing or claims processing experience
OTHER REQUIREMENTS:
• Must be able to type 30 words per minute (typing test required)
• Must have basic PC knowledge and working expertise with keyboard, mouse,
Internet, and Windows based applications
PREFERENCES:
Basic knowledge of Excel and Word
Knowledge of medical terminology
-
Claims Adjuster
Found in: beBee jobs US - 1 week ago
Albuquerque, New Mexico, United States Insurance Placement Solutions Full timeInsurance Placement Solutions has an immediate opening for a Remote Workers Compensation Claims Adjuster with our client. As a member of our client's claims team, utilize your knowledge of workers' compensation to independently investigate, evaluate and resolve assigned claims in order to achieve appropriate outcomes. In this position, you will administer...
-
Claim Representative, Medical Only
Found in: Resume Library US A2 - 1 week ago
Albuquerque, New Mexico, United States CCMSI Full timeOverview: At CCMSI, we look for the best and brightest talent to join our team of professionals. As a leading Third Party Administrator in self-insurance services, we are united by a common purpose of delivering exceptional service to our clients. As an Employee-Owned Company, we focus on developing our staff through structured career development programs,...
-
Albuquerque, United States CCMSI Full timeOverview: At CCMSI, we look for the best and brightest talent to join our team of professionals. As a leading Third Party Administrator in self-insurance services, we are united by a common purpose of delivering exceptional service to our clients. As an Employee-Owned Company, we focus on developing our staff through structured career development programs,...
-
Multi-Line Claim Adjuster, Senior
3 days ago
Albuquerque, United States CCMSI Full timeOverview:At CCMSI , we look for the best and brightest talent to join our team of professionals. As a leading Third Party Administrator in self-insurance services, we are united by a common purpose of delivering exceptional service to our clients. As an Employee-Owned Company, we focus on developing our staff through structured career development programs,...
-
Claims Adjuster
Found in: beBee S US - 1 week ago
Albuquerque, United States Insurance Placement Solutions Full timeInsurance Placement Solutions has an immediate opening for a Remote Workers Compensation Claims Adjuster with our client. As a member of our client’s claims team, utilize your knowledge of workers’ compensation to independently investigate, evaluate and resolve assigned claims in order to achieve appropriate outcomes. In this position, you will...
-
Multi-Line Claim Adjuster, Senior
1 week ago
Albuquerque, United States CCMSI Full timeOverview: At CCMSI, we look for the best and brightest talent to join our team of professionals. As a leading Third Party Administrator in self-insurance services, we are united by a common purpose of delivering exceptional service to our clients. As an Employee-Owned Company, we focus on developing our staff through structured career development programs,...
-
Senior Workers Compensation Claims Adjuster
3 days ago
Albuquerque, United States Arthur J. Gallagher & Co. Full timeJoin our growing team of dedicated professionals at Gallagher Bassett, who guide those in need to the best possible outcomes for their health and wellbeing. You'll be part of a resilient team that works together to redefine the boundaries of excellence. At our organization, we value collaboration and making a positive impact in the lives of our clients and...
-
Medical Billing- Reimbursement Services
1 week ago
Albuquerque, United States HME Specialists LLC Full timeJob DescriptionJob DescriptionAre you passionate about providing exceptional customer service in the medical supply industry? Do you thrive in a fast-paced, energetic environment? If so, we have an exciting opportunity for you to join our team as a Reimbursement Services- Billing Representative at HME Specialists, LLC in Albuquerque!As a Billing...
-
Medical Billing- Reimbursement Services
7 hours ago
Albuquerque, United States HME Specialists LLC Full timeJob DescriptionJob DescriptionAre you passionate about providing exceptional customer service in the medical supply industry? Do you thrive in a fast-paced, energetic environment? If so, we have an exciting opportunity for you to join our team as a Reimbursement Services- Billing Representative at HME Specialists, LLC in Albuquerque!As a Billing...
-
Workers' Compensation Adjuster
2 weeks ago
Albuquerque, United States New Mexico Mutual Full timeJob DescriptionJob DescriptionJob Title: Workers Compensation Medical Only Adjuster Department: Workers Compensation Reports to: Regional Claims ManagerPosition Summary: This position is responsible for the adjudication of medical only workers compensation claims, assigned by our clientele, in accordance with the New Mexico Workers Compensation Statute,...
-
Senior Workers Compensation Claims Adjuster
Found in: Resume Library US A2 - 7 days ago
Albuquerque, New Mexico, United States Gallagher Full timeAbout Us: Join our growing team of dedicated professionals at Gallagher Bassett, who guide those in need to the best possible outcomes for their health and wellbeing. You'll be part of a resilient team that works together to redefine the boundaries of excellence. At our organization, we value collaboration and making a positive impact in the lives of our...
-
Multi-Line Claim Adjuster, Senior
Found in: Resume Library US A2 - 2 weeks ago
Albuquerque, New Mexico, United States CCMSI Full timeOverview: At CCMSI, we look for the best and brightest talent to join our team of professionals. As a leading Third Party Administrator in self-insurance services, we are united by a common purpose of delivering exceptional service to our clients. As an Employee-Owned Company, we focus on developing our staff through structured career development programs,...
-
Medical Assistant
1 week ago
Albuquerque, United States Duke City Urgent Care Full timeJob DescriptionJob DescriptionSalary: $16 - 20 per hourDuke City Occupational Healthcare is looking to add an three exceptional Medical Assistant to join our team! At Duke City, we pride ourselves on offering fast, friendly, quality care to all residents of NM in need. If you are a positive, driven person who enjoys a challenging workplace and exudes a...
-
Sleep Coordinator
Found in: Lensa US P 2 C2 - 6 days ago
Albuquerque, United States Home Medical Equipment Specialists Llc Full timeAre you looking for an exciting career opportunity where you make a difference in people's lives daily? Then come join HME Specialists, we are New Mexico's largest local medical equipment and supply company!HME Specialists is a rapidly expanding company with a great work environment, career growth opportunities and great benefits. We offer Health, Dental and...
-
Cash Application Representative
1 week ago
Albuquerque, United States HME Specialists LLC Full timeJob DescriptionJob DescriptionAre you looking for an exciting opportunity to apply your financial expertise in a dynamic and customer-centric environment? Look no further! HME Specialists is currently seeking a Cash Application Representative to join our team in Albuquerque. As a Cash Application Representative, you will play a vital role in ensuring...
-
Cash Application Representative
Found in: beBee jobs US - 1 week ago
Albuquerque, New Mexico, United States HME Specialists Full timeAre you looking for an exciting opportunity to apply your financial expertise in a dynamic and customer-centric environment? Look no further HME Specialists is currently seeking a Cash Application Representative to join our team in Albuquerque. As a Cash Application Representative, you will play a vital role in ensuring accurate and timely processing of cash...
-
Director of Managed Care
4 days ago
Albuquerque, United States HME Specialists LLC Full timeJob DescriptionJob DescriptionAbout the jobHME Specialists is a fast growing primary player in NM providing Durable Medical Equipment, Home Infusion and LTC/Hospice services The Director of Managed Care & Contracting will oversee strategy and development for all Managed Care Services and Contracting for the LTC and New Vista lines of business. The Corporate...
-
Supply Inbound Specialist
2 weeks ago
Albuquerque, United States HME Specialists LLC Full timeJob DescriptionJob DescriptionAre you looking for an exciting opportunity where you can make a difference in people's lives? Look no further! HME Specialists LLC is seeking a Full-Time Supply Inbound Specialist to join our team in Albuquerque. As a Supply Inbound Specialist, you will play a vital role in ensuring that medical supplies and equipment are...
-
Insurance Verification Specialist/Front Desk
1 week ago
Albuquerque, United States New Haven Behavioral Health Services Full timeJob DescriptionJob DescriptionJob SummaryVerifies insurance policy benefit information and obtains Authorization/ Precertification, prior to the patient's visit or scheduled admission, or immediately following admission. Assist in identifying problems and ensures that the insurance is accurate on the patient account. Coordinates outstanding patient...
-
Accounting Specialist
6 days ago
Albuquerque, United States New Mexico Lottery Authority Full timeJob DescriptionJob DescriptionJOB TITLE: Accounting Specialist SALARY GRADE: 5DIVISION: Finance FLSA CODE: NEDESCRIBE PRIMARY REASON JOB EXISTS:Performs a variety of technical level accounting duties in support of the financial accounting functionand the Finance Division.ESSENTIAL FUNCTIONS: Accounts Payable %Time: 60% Frequency: DailyMajor Duties:1....