Accounts Receivable Claims Specialist (Chesapeake Specialty Care)

University of Maryland Faculty Physicians•Baltimore, MD

About The Position

The Accounts Receivable Claims Specialist is responsible for working with payors to resolve payment denials, both partial and full. This role requires staying current on payer policies and coverage guidelines, identifying payment denials through the work queue, and taking appropriate action to resolve them. The specialist will communicate professionally with providers when necessary to resolve denied claims, resubmit corrected claims based on payor policies or provider directions, and appeal claims denials with required information for proper adjudication. Staying current on correct appeal processes for assigned payors is also a key responsibility.

Requirements

High school diploma or equivalent
Minimum 2-3 years of experience in medical billing
Experience with practice management systems and EHR platform
Familiarity with medical terminology and CPT/ICD-10 codes
Strong knowledge of medical insurance plans (commercial, Medicare, Medicaid, Tricare)
Knowledge of basic medical coding and third-party operation procedures and practices.
Familiarity with Microsoft applications, including, but not limited to Word and Excel.
Excellent communication and customer service skills
Strong written and verbal communication skills including the ability to confidently speak to patients
Excellent organizational skills to manage multiple tasks throughout the day.
Ability to operate a multi-line telephone system and answer a telephone in a pleasant and helpful manner.
Demonstrate the ability to work as a team player in a very cohesive medical practice.
Ability to communicate and work well with co-workers. Open and honest communication.
Ability to effectively communicate orally and in writing with internal and external business professionals.
Must be responsible, reliable, and able to carry out job functions

Responsibilities

Stay current on payer policies and coverage guidelines.
Identify payment denials through the work queue and take appropriate action to resolve.
Communicate professionally with providers when necessary to resolve denied claims.
Resubmit Corrected Claims based on payor policies or Provider directions.
Appeal claims denials with required information to have claims adjudicated properly.
Stay current on correct appeal processes for Payors assigned.