Medical Claims Specialist

Location: Geneva, IL

Status: Full-time (40 Hours/Week)

Days/hours: Monday - Friday

Summary

Responsible for handling all phases of a claim, including gathering reports, investigating, and correcting any issues, collecting payments, determining coverage and closing files.

Essential Duties and Responsibilities

The essential duties and responsibilities include the following. Other duties may be assigned.

• Document all work activity accurately and professionally in the electronic health record (Athena One).

• Review patient records for completeness, appropriateness, timeliness, and accuracy of data.

• Maintain and organize registry and clinical database information.

• Obtain prior authorization for patients from their health insurance for treatments of procedures.

• Verify patient eligibility.

• Contact other healthcare providers to ensure the accuracy of medical records.

• Assign clinical codes via classification software for data analysis and reimbursement.

• Gather and process the information required to complete the medical insurance claims process.

• Determine covered medical insurance losses, document medical claims actions, and resolve claims through approval or denial of documentation.

• Identify and recover outstanding balances on designated accounts listed on the aging report.

• Establish payment plans for outstanding balances.

• Correspond with insurance companies and/or patients to resolve questions they may have regarding a claim or balance.

• Obtain patient payments.

• Place ‘alerts’ in patients’ charts of payments that need to be collected at time of service.

• Handle phone, email, US mail insurance correspondence.

• Update patient collection accounts and communicate with collection agencies as needed

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

Education and/or Experience

Required:

• High school diploma or equivalent.

• Two (2) plus years of relevant accounts receivable, billing and/or collections work experience.

• Experience working with EHR (Electronic Health Record) systems.

Preferred:

• Undergraduate degree, preferably in business or a related and/or equivalent field of study.

• Previous work experience in a healthcare environment.

• Previous work experience in an ambulatory surgery center.