Medical Claims Specialist

Immediate position available for a Medical Claims Specialist.

A minimum of one (1) year medical office experience involving medical billing is required. An equivalent combination of relevant education and/or training can be substituted for experiences.

Duties Include but are not limited to:

• All Processes referrals and Medical / Transportation claims for beneficiaries authorized to receive health services from facilities and providers
• Determine patient’s eligibility according to established policies and procedures.
• Determines payable claims and submits purchase orders.
• Provide assistance to patients, carriers, and other external partners. Answers incoming phone calls and review incoming correspondence and materials, accurately interprets and communicates Medical Claims regulations, policies, and procedures to internal and external customers.
• Research unauthorized claims, referral and claim status, and other customer inquiries in a timely, efficient, and appropriate manner to ensure customer satisfaction.
• Verify patient and insurance information according to established procedures; obtains alternate health resource information, including Medicaid, Medicare, private insurance, and other liability coverage, prior to authorizing referrals and issuing purchase orders
• Prepare/ assist in the preparation of month end reports through desk audit, pending claims reporting from fiscal intermediary, and aging PO’s clean up.
• Other duties as assigned

Pay starting at $21.54/HR Based on experience. Monday -Friday 8am-5pm

Requirements:

• High School diploma or equivalent
• Minimum of 1 year of medical office experience involving medical billing.
• Background will be viewed
• Drug free environment