What are the responsibilities and job description for the Medical Claims Specialist position at Pulmonary & Critical Care Specialists of NOVA?
We are seeking a qualified and dedicated medical claims specialist to join our billing office. As our medical claims specialist, you’ll determine whether patients have insurance coverage and help them with their medical claims. You’ll also make sure all actions taken are thoroughly documented and that you adhere to our policy of delivering quality customer service to each of our patients and their families. You must also ensure 100 percent legal and industry compliance throughout the entire claims process.
To succeed in this role, you must possess in-depth knowledge of billing software (we use Greenway Intergy) and medical insurance policies. The ideal candidate must also be able to demonstrate excellent written and verbal communication skills, as communicating with clients and various insurance agents will form a large part of the job. We are looking for someone who is focused on accuracy and detailed orientated.
Medical Claim Specialist Responsibilities:
- Manage all appeals, including redeterminations & reconsideration
- Detail knowledge of medical coding; ICD-10, CPT and HCPCS codes.
- Confirm coverage and work with private payers, commercial payers, Medicaid, and Medicare for reimbursement of provide medical services
- Audit encounters and ICD-10 codes to ensure correct coding and maximum reimbursement
- Perform claims processing, medical billing, cob and process insurance appeals.
- Assist with special reports of tracking problem medical claims according to HIPPA guidelines.
- Review documentation, analyze reject claim data, justify CPT & HCPCS codes and pay HCFA-1500
- Obtain and enter demographic information into the computer system
- Determine whether members have additional medical coverage and coordinates claims processing with other carriers as necessary.
Medical Claim Specialist Responsibilities:
- Bachelor’s degree in business, health care administration, accounting or relevant field.
- A minimum of 2 years’ experience as a medical claim specialist or similar role.
- Solid understanding of billing software and electronic medical records.
- Must have the ability to multitask and manage time effectively.
- Excellent written and verbal communication skills.
- Outstanding problem-solving, organizational and time management abilities.
Job Type: Full-time
Pay: $20.00 - $23.00 per hour
Expected hours: 40 per week
Benefits:
- 401(k)
- Dental insurance
- Flexible schedule
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
- Work from home
Schedule:
- 8 hour shift
- Day shift
- Monday to Friday
Education:
- Bachelor's (Required)
Experience:
- Medical Claims Specialist or related field: 2 years (Required)
- Medical office: 2 years (Required)
- EMR systems: 2 years (Required)
License/Certification:
- Medical Billing and Coding Certification (Preferred)
Shift availability:
- Day Shift (Required)
Ability to Commute:
- Fairfax, VA 22033 (Required)
Work Location: Hybrid remote in Fairfax, VA 22033
Salary : $20 - $23