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Medical Claims Specialist

Roseville, CA

Posted: 01/15/2020 Employment Type: Temporary Position Industry: Healthcare/Medical Job Number: 41955.1

Job Description

An established healthcare organization in Roseville is seekign Claims Specialist to support their billing department. The Medical Claims Specialist supports the delivery of all billing services by auditing, correcting, and submitting 3rd party claims and patient statements. Ideal candidates will have experience with HMO and PPO medical claims. This is a long term contract opportunity, with full-time hours, Monday - Friday.

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.

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