Medical Claims Specialist

PAI - Connecting People Payments & Processes

Job Title: Medical Claims Specialist/CSR
Location: Glastonbury, Connecticut (on-site)

Schedule: 11:30am-8pm Monday - Friday

PAI is a growing company looking for a Medical Claims Specialist with at least 2-years of prior experience. Ideal candidate should have knowledge of medical billing, EOBs and medical insurance practices. Ability to work in a fast-paced environment and have strong interpersonal/communication skills and attention to detail.

Candidate will perform administrative tasks related to client out of pocket medical expenses, interact with clients to provide information in response to inquiries about products and services.

Duties and Responsibilities include the following.

Processes or adjust medical insurance claims in accordance with policies and procedures.

Answers phones and respond to client inquiries related to payments made on their behalf to medical providers.

Answers phones and responds to medical provider inquiries related to payments made or due to their office on their behalf of program clients.

Makes outgoing calls to medical providers and insurance companies.

Responsible for having the ability to read explanation of benefits and healthcare terminology.

Identifies, researches, resolves claim issues, and requests for additional documentation.

Promotes teamwork and service delivery success.

Ensures contractual performance guarantees related to payment processing timeliness and accuracy are met.

Ensures contractual performance guarantees related to various means of client communications are met such as phone, email, and mail.

Processes medical payments for clients.

Assists with denials and the client appeals process.

Creates and updates financial batch records for processing by accounting.

Audits payment files and outgoing payments and checks accuracy of figures calculation.

Manages workflow to ensure service levels are achieved.

Manages call logs and call notes.

Works with client’s that have high medical utilization.

Recommends process improvements.

Performs other duties as assigned.

Education/Experience:
Associate's degree (A. A. / A. S.) or equivalent from two-year college or technical school; or two to four years related experience and/or training; or equivalent combination of education and experience.

Specialized Training:

Knowledge of medical insurance practices, payment terms related to medical insurance out of pocket expenses, benefits coordination with other insurance coverage, and ensuring payer of last resort.

Certificates and Licenses:
Medical coding/billing or insurance claims processing a plus

Knowledge, Skills, and Other Abilities:

• Speaking which includes talking to others to actively convey information effectively and looking for ways to help people.
• Knowledge of medical insurance practices, medical explanation of benefits (EOBs)
• Proficiency with all MS Office applications including Microsoft Excel, Microsoft Word, and Microsoft Outlook
• Active Listening which includes strong problem solving and attention to detail. Ability to exercise sound judgment taking time to understand the points being made while asking questions as appropriate.

The above is intended to provide general guidance regarding the responsibilities of the position. It is not intended to be an all-encompassing definition of what the position entails and may be changed at the discretion of Senior Management at any time.

PAI is an equal employment and affirmative action employer. All qualified applicants will receive consideration without regard to race, color, sex, religion, age, national origin, disability, veteran status, sexual orientation, gender identity or expression, marital status, ancestry or citizenship status, genetic information, pregnancy status or any other characteristic protected by law.

Job Type: Full-time

Pay: From $23.50 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Application Question(s):

• Can you work 11:30am - 8pm Monday - Friday?

Experience:

• Medical Billing: 2 years (Required)

Language:

• Spanish (Preferred)

Work Location: In person

Salary : $24