Medical Claims Specialist

SPINE TEAM TEXAS MANAGEMENT COMPANY•Southlake, TX

4d•Onsite

About The Position

The Medical Claims Specialist is responsible for timely and accurate processing of medical insurance claims, resolution of claim edits and rejections, coordination of secondary billing, and preparation of payment posting batches. As a key member of the revenue cycle team, this position ensures claims are properly submitted, clearinghouse edits are resolved, payments are tracked, and supporting documentation is accurately maintained to maximize reimbursement and minimize claim delays. The position requires full understanding of and active participation in fulfilling the mission of Spine Team Texas. It reports directly to the Revenue Cycle Manager, who is under the direction of the Director of Revenue Cycle. All employees are expected to demonstrate the Spine Team Texas attributes, including knowledge, quantity and accuracy of work, judgment, innovation, orderliness, courtesy, cooperation, initiative, reliability, perseverance, stability, alertness, professionalism, teamwork, observance of company policies and procedures, and consistent attendance. Employees are also expected to provide courteous, professional customer service and contribute positively to the team and the company’s mission of offering an unparalleled patient experience. The role is based at the Southlake Headquarters in Southlake, Texas. The work environment is a well-lit, air-conditioned office. The position requires sitting for long periods, lifting at least five pounds, and working under pressure. Tasks involve no exposure to blood or other potentially infectious materials.

Requirements

High school diploma or equivalent.
Two to three years of experience in medical billing, insurance claims processing, or revenue cycle management operations.
Knowledge of insurance claim submission processes and reimbursement procedures.
Knowledge of EOBs, claim edits, denials, rejections, and secondary billing procedures.
Strong organizational skills and attention to detail.
Proficiency in document scanning.
Strong proficiency in Microsoft Office applications.
Proficiency communicating in English, both written and verbally.
Ability to sit for long periods and lift a minimum of five pounds.
Ability to work under pressure.
Ability to follow HIPAA regulations and organizational policies.

Nice To Haves

Medical billing certification.
Preferred knowledge of CPT, ICD-10, and HCPCS coding systems.
Familiarity with electronic health records (EHR), practice management systems, and clearinghouses.

Responsibilities

Prepare, review, and submit medical claims to insurance carriers in a timely and accurate manner.
Monitor claim batch status and investigate errors.
Review and resolve claim edits through clearinghouses and payor portals.
Submit secondary claims using information provided on primary payer EOBs.
Scan, upload, and electronically file EOBs, insurance correspondence, checks, and billing documentation.
Open, sort, and distribute mail.
Print and distribute faxes.
Prepare payment batches according to protocol for payment posting.
Maintain detailed records of all claim submissions.
Ensure full compliance with HIPAA regulations and organizational policies.
Perform other duties and responsibilities as assigned.
Maintain courteous and professional communication with patients, customers, and coworkers.
Contribute positively to the team and promote cooperation across the unit, department, and company.