Medical Claims Specialist

Job Description

Job Description

Position Summary
The Medical Claims Specialist is responsible for the accurate and timely submission, tracking, and resolution of medical claims for services. This role ensures claims are processed in compliance with payer requirements and organizational policies, while maximizing reimbursement and maintaining excellent customer service.

Key Responsibilities

• Submit medical claims (electronic and manual) to insurance carriers, Medicaid, and managed care organizations
• Review Explanation of Benefits (EOBs) and Remittance Advices; investigate and resolve denials
• Correct and resubmit claims in accordance with payer guidelines and timelines
• Monitor accounts receivable, including aged balances and open claims, and follow up to ensure payment
• Manage appeals processes and pursue reimbursement through all available channels
• Ensure accuracy and compliance of all claim submissions (including CMS forms and ANSI837 standards)
• Post payments accurately to patient accounts
• Maintain payer contact information and stay updated on billing requirements
• Work to ensure claims are resolved within established timeframes
• Provide professional and responsive service to internal and external stakeholders

Qualifications & Skills

• Knowledge of medical billing, claims processing, and insurance procedures
• Familiarity with electronic claims submission standards (e.g., ANSI837, HIPAA compliance)
• Strong attention to detail and ability to manage multiple claims and deadlines
• Analytical and problem-solving skills for denial resolution and accounts reconciliation
• Effective communication and customer service skills
• Ability to work independently and collaboratively

Connecticut Counseling Centers, Inc. is a not-for-profit corporation that provides a full range of licensed outpatient substance abuse and mental health prevention, education, and treatment services to assist adults in becoming productive members of society.

Company Description

Connecticut Counseling Centers, Inc. is a not-for-profit corporation that provides a full range of licensed outpatient substance abuse and mental health prevention, education, and treatment services to assist adults in becoming productive members of society.