Medical Claims Processor

Job Description:

The Medical Claims Biller is responsible for monitoring insurance carrier adjudication of TeamVision medical claims for one or more doctor practices. Utilize a practice EHR system and clearing house to review and submit claims to multiple medical insurance carriers Review open/unpaid claim balances and take required action.

MAJOR DUTIES & RESPONSIBILITIES

• Review medical claims and transmit to the insurance carrier using the practice electronic health records (EHR) system and clearing house.
• Monitor rejected claim reports and adjust claims for resubmission to the insurance carrier.
• Download insurance carrier explanation of payments (EOPs) to post claim payments and denials in the EHR system.
• Determine if denied claims can be corrected and re-submitted to the carrier.
• Review aging reports to research open balances and resubmit within insurance carrier filing limits.
• Utilize insurance carrier websites and contact carriers as needed to investigate denials and claim status.
• Partner with the clearing house to distribute patient billing statements and monitor the patient portal to post payments in the EHR system.
• Initiate overpayment refunds to patients and repayments to insurance carriers when required.
• Serve as the point of contact for the practice regarding all vision and medical claims.
• Support the corporate manager in maximizing claim collection rate.

BASIC QUALIFICATIONS

• High school diploma
• 3+ years of related work experience
• Experience with medical billing and coding
• Ability to prioritize handling of issues
• Organization skills and ability to multitask
• Effective communication skills (verbal, written, listening, presentation)

PREFERRED QUALIFICATIONS

• Experience working in multiple doctor practices
• Experience working with multiple insurance carriers and an understanding of their claim requirements
• Proven ability to identify issues and solve problems