Medical Billing / Claims Administrator

Ametros•Wilmington, MA

2d•$25 - $29•Hybrid

About The Position

Ametros is changing the way individuals navigate healthcare by providing them with the tools and support necessary to make educated decisions on how to spend their medical funds. Ametros's team works closely with patients, insurers, employers, attorneys, brokers, medical providers, and Medicare to create a seamless experience for our clients. Our flagship product is revolutionizing the way funds from insurance claim settlements are administered after settlement. Ametros continues to innovate, bringing new solutions to the market with the goal of simplifying healthcare for our clients. We make managing medical funds safe, effortless, and cost effective for everyone. The Claims Specialist plays a critical role in the end-to-end management of member claims, ensuring accuracy, timeliness, and compliance across all claim-related activities. This position requires strong analytical skills, attention to detail, and the ability to collaborate across departments and with external partners to resolve complex issues and improve operational efficiency. The Claims Specialist plays a critical role in the end-to-end management of member claims, ensuring accuracy, timeliness, and compliance across all claim-related activities. This position requires strong analytical skills, attention to detail, and the ability to collaborate across departments and with external partners to resolve complex issues and improve operational efficiency.

Requirements

Well versed with healthcare and medical terminology.
Excellent written and verbal communication skills with ability to adapt communication style depending on audience.
Understanding of Worker’s Compensation and Medicare coverage guidelines.
Meticulous attention to detail.
Highly organized and focused with the ability to prioritize and multitask.
Aptitude for problem-solving.
Sound business judgment and computer skills.
A desire to continue to learn and improve both self and the organization.
Ability to work both independently and collaboratively within a team environment.
H.S. Diploma or General Education Degree (GED) required
3-4 years experience with ICD-10, CPT, NDC and HCPCS coding and procedures required
3-4 years Healthcare industry medical billing experience strongly preferred

Nice To Haves

Bachelor’s Degree in Arts/Sciences (BA/BS) preferred

Responsibilities

Assess claims to determine whether services are related to covered injuries and compliant with the guidelines of the member's settlements, ensuring appropriate benefit coordination.
Maintain comprehensive documentation of all claim-related communications, ensuring timely follow-up and resolution.
Proactively detect claim discrepancies, errors, or delays and collaborate with internal teams and providers to drive swift resolution.
Manage transitions for claims outside of CareGuard coverage, ensuring seamless member experience and accurate benefit coordination.
Handle inbound and outbound calls, emails, and chats related to claims, coverage guidelines, and provider inquiries providing expert-level support and guidance to a wide variety of audiences.
Oversee the bill payment process, including detailed review and validation of claims to ensure proper fund allocation and compliance.
Audit electronic claims feeds and bill review workflows to ensure data accuracy and operational integrity.
Partner with IT and Management to identify and resolve system-related issues impacting claims processing.
Coordinate with external vendors to resolve billing discrepancies and ensure alignment with contractual terms.
Act as a resource for Member Care and Pharmacy representatives, offering guidance and support on billing and claims procedures.
Identify opportunities for improvement within existing claims workflows and contribute to process enhancement initiatives.
Generate ad hoc reports in Excel to support management decision-making.
Lead or contribute to special projects and initiatives as assigned by Management, driving innovation and continuous improvement.
Conduct research and analysis to support the resolution of claims.