Claim Specialist/Coder

Job Description

Job Description

Overview
We are seeking a detail-oriented and highly skilled Claim Specialist/Coder to join our busy Ophthalmology Surgery Center. The ideal candidate will possess a comprehensive understanding of medical coding, billing, and claims processing, ensuring accurate and efficient submission of insurance claims and processing claim denials and appeals. The Claim Specialist/Coder will play a vital role in optimizing revenue cycle operations while maintaining compliance with industry standards and regulations. Hours are Monday through Friday 8:00am to 4:30pm.

Responsibilities

• Resolve claim denials or rejections and implementing corrective actions with the proper appeals.
• Collaborate with medical biller to ensure proper documentation supports coding decisions and accuracy.
• Occasional billing of charges.
• Stay current with updates to coding guidelines, payer policies, and regulatory changes affecting medical billing practices.
• Maintain detailed records of claim submissions, adjustments, and follow-up with medical records requests.
• Must be able to multitask and work in a team environment.

Qualifications

• Three years minimum experience
• Proven experience in medical coding, billing, or claims processing within a healthcare setting.
• Excellent attention to detail with the ability to interpret clinical information accurately.
• Effective communication skills for collaborating with healthcare providers, insurance companies, and internal teams.
• Extensive knowledge of insurance-related policies
• Knowledge of Medicare rules, local and national coverage determination.
• Ophthalmology knowledge a bonus
• Ambulatory Surgery Center claim knowledge a bonus

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Health savings account
• Life insurance
• Paid time off