Medical Claims Specialist
3 weeks ago
- Claim Verification: Utilize various hospital and physician systems to ensure patient, billing, and claim information accuracy.
- Billing Compliance: Perform primary, secondary, and tertiary billing functions, including electronic, paper, and portal submission to government and commercial payers.
- Claim Editing: Edit claims to meet and satisfy billing compliance guidelines for electronic and hardcopy submission.
- Communication: Respond to emails and telephone messages in a timely manner and communicate issues to management.
- Professional Development: Participate in meetings, training seminars, and adhere to professional standards, hospital policies, and procedures.
Additional Responsibilities:
- Provider Billing Manuals: Utilize provider billing manuals to obtain billing guidelines and requirements.
- Import/Export Files: Import verification and escalation of import/export files.
- Special Handling Billing: Handle interim bills, overlap review, redistribution of money for correct claim creation, and resolve billing rejections.
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Medical Claims Specialist
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Medical Insurance Claims Specialist
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