Medical Claims Processor

Job Description

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

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

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

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