Medical Claims Specialist

Bright Futures Psychiatry•Colorado Springs, CO

2d•$23 - $28

About The Position

The Medical Claims Specialist (MCS) plays a critical role in the revenue cycle by ensuring accurate claim submission, timely payment posting, denial resolution, and reimbursement optimization. The position works closely with payers, providers, and internal departments to identify reimbursement issues, resolve claim barriers, and improve overall revenue cycle performance. The ideal candidate demonstrates accountability, attention to detail, and persistence when solving complex reimbursement challenges. They are highly organized and analytical, and committed to delivering accurate results in a fast-paced healthcare environment.

Requirements

High school diploma or equivalent.
Minimum of two years of recent experience in medical billing, claims management, accounts receivable, or revenue cycle.
Working knowledge of medical billing, insurance claims processing, and denial management.
Proficiency with electronic health records (EHRs), practice management systems, Microsoft Office, and Google Workspace applications.
Exceptional written and verbal communication skills.
Exceptional attention to detail, accuracy, and organizational skills.

Nice To Haves

Experience in behavioral health, psychiatry, or mental health billing.
Direct, recent experience with insurance payment posting and reconciliation.
Knowledge of CPT, ICD-10, and HCPCS coding.
Experience preparing and managing insurance appeals.
Familiarity with AdvancedMD or similar healthcare software.

Responsibilities

Serve as a primary point of contact for phone calls and internal communications.
Post and reconcile insurance and patient payments accurately and timely.
Review claims for billing, coding, and documentation accuracy prior to submission and when researching payment issues.
Investigate, analyze, and resolve denied, underpaid, or delayed claims by identifying root causes and implementing corrective actions.
Prepare, submit, and track appeals to ensure timely resolution and maximum reimbursement.
Monitor denial and reimbursement trends and proactively recommend process improvements to reduce future claim issues.
Maintain accurate and thorough documentation of all account activity within the electronic health record and practice management systems.
Collaborate with providers, clinical support staff, and other departments to resolve billing and reimbursement concerns.
Stay current on payer policies, reimbursement guidelines, coding updates, and industry best practices.
Participate in departmental projects and perform other duties as assigned.