Medical Claims Specialist - Hybrid

AC3 Inc•South Bend, IN

4h•Hybrid

About The Position

AC3 was founded by practicing oncologists along with data and practice analytics experts to support the business side of medicine. Our mission is to modernize and digitize the delivery of healthcare and improve countless lives along the way. We combine the power of big data technology and people to enable easier frontline decisions about complex problems. AC3 offers its employees an exciting, fast-paced, and challenging work environment. To learn more about AC3, visit us at www.ac3health.com. Our company mission is to simplify healthcare and reduce the cost of care, empowering care givers to focus on what matters most – fighting cancer. This position is responsible for gathering and processing the information required to complete the medical insurance claims process. They will be responsible for documenting and entering required information in our systems. The team member is also responsible for ensuring the collection of outstanding accounts from insurance carriers, monitoring claims submission, writing letters of appeal, reviewing, and obtaining necessary documentation to submit claims. He/she will notify the Team Leader and Revenue Cycle Manger of any claim submission errors or specific payer issues to ensure the department.

Requirements

Claims experience in a hospital or inpatient setting.
High school diploma or equivalent (GED).
Accurately maintains and adheres to all safety rules and regulations.
Must be detail oriented and have problem solving abilities.
Working knowledge/experience in electronic medical records and/ or other medical software if applicable.
Must possess the ability to work with patients and family members in a confident, respectful, and socially professional manner.
Must rely on experience and judgment to plan and accomplish goals.
Excellent communication and organizational skills with the ability to work in a fast paced environment; prioritize tasks and workloads.
Performs other duties as assigned.

Nice To Haves

Medical office experience/medical terminology preferred.
Proficient in Microsoft Office preferred.

Responsibilities

Monitors delinquent accounts and assists in resolving issues to obtain payment.
Compiles letters of appeal complete with LCD/NCD/ payer requirement citations.
Knowledge of HCPCS codes and track payer policy changes to communicate with team.
Interprets and utilizes medical policies and procedures.
Maintains login credentials and access to all assigned payer portals.
Monitors and works assigned tasks in PM system to maintain productivity metrics.
Responds to all correspondence to clients and RCM team timely.
Disputes and works all necessary zero pays, underpayments, and denials.
Prevents all possible “timely follow-up” denials on claims or appeals.
Determines covered medical insurance losses and overpayments.
Documents all medical claims actions and resolutions as specified in SOP.
Analyzes insurance claims to prevent fraud.
Maintains the practices and principles set forth by AC3 leadership with a strong commitment to service, excellence, and quality.
Maintains professional behavior, confidentiality, and discretion at all times, along with the ability to work with all levels of staff with a confident and professional demeanor.
Follows HIPPA rules and regulations.

Benefits

Ongoing training, support, and a work culture like no other.
Medical health and wellness benefits.
Dental health and wellness benefits.
Vision health and wellness benefits.
Employer paid life insurance.
Employer paid long-term disability policies.
Employer paid short-term disability policies.
Above average paid time out plan.
Comprehensive wellness program, including onsite biometrics and ongoing mental and physical wellness support.
Access to company sponsored financial wellness counselors.
Employee assistance services.
Opportunity to enroll in our company-matched, 401k plan.