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Medical Claims Specialist
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At our organization, we are seeking a skilled professional to manage insurance claims, invoices and payments. The ideal candidate will also read patient charts to determine medical history, including diagnoses and treatments given.
Job Responsibilities- Reviewing and analyzing patient records to ensure accuracy and completeness.
- Obtaining referrals and pre-authorizations as required for procedures, ensuring compliance with regulations and policies.
- Determining the correct codes for patient records, utilizing knowledge of medical terminology and coding systems.
- Checking eligibility and benefits verification for treatments, hospitalizations and procedures, and communicating with patients and family members regarding their status.
- Using codes to bill insurance providers efficiently and accurately, minimizing delays and errors.
- Reviewing patient bills for accuracy and completeness, obtaining any missing information and resolving discrepancies in a timely manner.
- Interacting with physicians and assistants to ensure accuracy and consistency in patient care, and maintaining effective communication with patients and their families.
- Keeping track of patient data over multiple visits, using data management systems to monitor progress and identify trends.
- Following up on unpaid claims within the standard billing cycle timeframe, ensuring that all necessary documentation is complete and accurate.
- Maintaining detailed, specifically-coded information for each patient, adhering to confidentiality and security protocols.
- 1-2 years of experience in Medical Coding and Billing.
- Experience in Billing/Coding with Aetna, Cigna, Blue Cross Blue Shield, United Health and others is preferred.
- Knowledge of insurance guidelines, including Medicare, Medicaid and other payer requirements and systems.
- Effective communication abilities for phone contacts with insurance payers to resolve issues, and customer service skills for interacting with patients regarding medical claims and payments.
- Problem-solving skills to research and resolve discrepancies, denials, appeals and collections.
- Knowledge of medical terminology likely to be encountered in medical claims.
- Amenable to work with a flexible schedule.
The selected candidate will work in Tanay, Rizal, in a dynamic and fast-paced environment.
DisclaimerThe above statements are intended to describe the general nature and level of work being performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties, and skills required of personnel working within this job title.
