Medical Claims Denial Specialist
About The Position
The Claims Denial Specialist is responsible for accurately processing insurance explanation of benefits (EOB’s), investigating denials, communicating with the insurance companies, office sites, and customer service department regarding claims, re-bill claims and works aging and ERA reports in a timely manner. This role requires a strong understanding of medical terminology, billing terminology (ICD and CPT codes), and patient confidentiality. The specialist will utilize the practice management system and electronic medical record, research coding issues using various resources, and communicate effectively with internal teams and external insurance companies.
Requirements
- High School Diploma or Equivalent
- Basic knowledge and understanding of patient confidentiality
- Knowledge of medical terminology
- Strong computer skills
- Knowledge of billing terminology (ICD and CPT codes)
- Ability to type using appropriate grammar and spelling
- Excellent phone etiquette and verbal communication
- Ability to work independently on assigned tasks as well as take direction from coordinator/manager
- Strong organizational and time management skills
Nice To Haves
- Completion of a Medical Coding and Billing Program
- Medical Coding Certification optional (CPC-A or CPC)
Responsibilities
- Investigate claims denials; refund request and/or other billing issues
- Re-bills/reprocesses claims correctly
- Research coding issues using appropriate resources (Supercoder, NCCI, CPT, payer websites, etc.)
- Quarterly review assigned payer insurance updates
- Utilization of the practice management system and electronic medical record (includes but not limited patient notes, claim data, tasks)
- Communicate with Coordinators regarding billing errors or denials
- Read and/or acknowledge email correspondence daily
- Acknowledge or work tasks daily
Benefits
- Salary will commensurate with medical billing experience including coding certification.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
