Medical Claims Specialist - Hybrid

AC3 Inc • South Bend, IN

2d • Hybrid

About The Position

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

• This position requires 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

• medical, dental and vision health and wellness benefits
• employer paid life insurance, long and 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

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED