What are the responsibilities and job description for the Medical Claims Specialist position at Vanguard Group Staffing?
Long Term Temporary, Possible Temporary- to -Direct Hire Medical Billing/Claims Coordinator - Monday through Friday, 9am to 5pm, Fully On-Site.
- Communicate via telephone and written correspondence with providers, members, attorneys, and collection agencies to resolve balance billing/fee negotiation inquiries.
- Handle large call volume.
- Negotiate and resolve balance billing inquires, negotiate fees and discounts for members with nonparticipating providers to reduce out of pocket expenses.
- Analyze correspondence; verify member eligibility, claim history and coordination of benefits.
- Review claims to determine if appropriate action was taken; follow up with Claims and Recovery Units to initiate adjustments and recover money.
- Identify billing anomalies and alert the Fraud and Abuse Department to reduce fraudulent billing practices.
- Triage balance billing/fee negotiation inquiries and ensure all documents are processed in a timely and efficient manner.
- Research provider contracts and lease network reports to ensure providers are not breaching contracts by referring members out of network.
- Perform additional duties and projects as assigned by management.