Job Openings in Sacramento County and Beyond
Medical Claims Specialist
Responsibilities: Performs all billing and follow-up functions, including the investigation of payment delays resulting from pended claims. Submits 3rd party claims and patient statements including the maintenance of bill holds and the correction of errors. Edits technical (UB-04) claim forms within the patient accounting system and external Claims Scrubber. Researches claim rejections, making corrections, taking corrective actions and/or referring claims for timely resolution. Conducts account follow up including the investigation of payment delays resulting from pending claims. Evaluates accounts, resubmits claims, and performs refunds, adjustments, write-offs and/or balance reversals, if charges were improperly billed or if payments were incorrect. Responds to customer service inquiries, complaints or issues regarding patient billing and collections (telephone, fax, mail and web-based patient portal).
Requirements: 1-2 years' medical claims experience. Certified Billing & Coding highly desirable. Demonstrated experience working with Medicare, MediCal, Medicaid, HMO, and PPO Claims standards, processes, policies, procedures and service level agreements. Familiarity with medical terminology and the medical record coding process. In-depth knowledge of Revenue Cycle applications, including Hospital Patient Accounting. Type 50 wpm. High attention to detail and accuracy. Excellent communication skills (verbal and written). Strong ability to identify, prioritize, resolve and / or escalate complex problems promptly. Ability to use good judgement and clear a criminal background check.