Medical Claims Specialist

Job Description

Job Description

JOIN OUR GROWING CLAIMS DEPARTMENT AT MEDLYTIX!

The Claims Resolution Specialist plays a key role in resolving open receivables for our clients.

You will process medical (physician and hospital) bills that involve motor vehicle accidents, workers' comp, and third-party claims. The Claims Resolution Specialist will work toward increased reimbursement and account resolution.

Responsibilities:

• Works independently to identify issues with claim submissions; identifies corrective steps; follows issue through to resolution.
• Provide exceptional customer service for inbound calls.
• Interface with insurance agents, patients, and others to the disposition of each account.
• Identify obstacles to claim submission and payment, including updating insurances, adjuster contact information, submitting bills, and providing requested documentation.
• Identify patterns with payers that result in non-payment or delayed payment. Ability to summarize and escalate in the correct manner.
• Update accounts in our proprietary technology platform to increase probability of collection and resolution of accounts.
• Rely on experience and judgment as well as instructions and pre-established guidelines to plan and accomplish goals and perform a wide variety of tasks.

Required Skills:

• Experience in healthcare revenue cycle, particularly physician billing, claims resolution, and customer service.
• Understanding and concern for patient privacy and HIPAA compliance
• Ability to interpret payer EOBs and understanding of coordination-of-benefits concepts.
• Excellent customer service, verbal and written communication skills
• Ability to review and interpret account information to successfully resolve account issues.
• Attention to detail in identifying, comparing & transferring data (particularly numbers)
• Ability to effectively navigate multiple systems to download & transfer files.
• Ability to research & follow written guidelines to determine next steps when conflicting information is presented
• Ability to identify trends/issues and communicate these to supervisors.
• Basic-to-Intermediate Microsoft Excel Skills
• Excellent Data Entry Skills

Education and Experience:

• Bachelor's degree preferred, High School diploma or GED required
• Health Information Management credential (RHIA, RHIT, CAHIMS, CPHIMS) preferred
• 2+ Years of Healthcare Revenue Cycle Experience
• Inbound Call Center Experience
• Preferred bilingual - fluent in speaking Spanish
• Preferred prior experience as team-lead, supervisor, or manager

Location: Roswell, Georgia (hybrid role) OR Ohio (fully remote)

Why Medlytix ?

• Competitive Pay
• Competitive Paid Time Off
• Comprehensive Medical, Dental, Vision and 401K Packages
• Family Support Benefits
• Paid Company Holidays

As part of our commitment to quality and excellence, Medlytix will continue to maintain a safe and healthy environment for you by requiring all applicants to submit to a criminal history check and those tentatively selected for a position to submit to screening for illegal drug use prior to appointment for a job. In addition, applicants may be screened for ability to perform essential functions of some positions.