Medical Claims Specialist

SunStone Consulting LLC; York (York County); Hybrid; USD 42,000 - 54,000; Full time

Job summary

SunStone Consulting LLC is seeking a Medical Claims Specialist in York, PA. This full-time role requires in-person attendance at the York office and entails submitting medical claims to insurance providers for payment to medical providers.

Daily duties include client communications, data verification, and timely claim filing within HIPAA guidelines. The position operates in a hybrid home office/hospital office environment with standard office equipment.

Qualifications

• High school diploma or equivalent required.
• Prior office experience preferred.
• HIPAA and PHI guidelines understanding is desirable.

Responsibilities

• Submit medical claims to insurance companies for payment to providers.
• Communicate with clients, adjusters, providers and others to complete tasks.
• Verify patients’ employer and workers’ compensation/auto insurance coverage.
• Ensure all required data elements are completed on claim forms.
• Prepare UB04 forms, detailed bill, medical records and reports for submission.
• Communicate with insurance companies to expedite payments and resolve underpayments.
• File Applications for Fee Reviews with PA Bureau of Workers’ Compensation when needed.
• Document patient accounts accurately in the provider system and HIPAA compliant.

Skills

Fast learner

Attention to detail

Independent worker

Multitasking

Deadline driven

Communication skills

Education

High school diploma or equivalent

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Medical Claims Specialist

Revenue Management Outsourcing Full Time York, PA York, PA, US

2 days ago Requisition ID: 1008

Medical Claims Specialist

The Medical Claims Specialist position is part of SunStone Consulting’s Pennsylvania Workers’ Compensation and Auto billing and collection outsourcing practice. Medical Claims Specialists are responsible for submitting medical claims to insurance companies for payment to the medical provider for services rendered. This position will routinely communicate with clients, insurance adjusters, insurance providers, and others to complete a variety of time-sensitive tasks within required deadlines. Please note: This position requires regular, in-person attendance at the York, PA office location of our client. We are unable to offer fully remote work or relocation assistance for this role. Candidates must already reside within a daily commutable distance.

Essential functions:

• Routinely achieving an average goal of 195-215 claim activities (i.e. billed, documented, adjusted, refunded, denied, etc.) per day.
• Regularly communicating with clients and managing client work queues.
• Verifying patients’ employer and workers’ compensation/auto insurance coverage.
• Reviewing and confirming that all required data elements have been completed on the claim forms.
• Compiling all the necessary documents to submit a medical claim, including the UB04 claim form, detailed bill, relevant sections of the patient’s medical record and the medical report form.
• Effectively communicating with insurance adjusters and other personnel by phone, fax, e-mail, and postal mail to expedite medical claim payments.
• Effectively and timely communicating with insurance companies by phone, fax, e-mail, and postal mail to resolve underpayments.
• Filing Application for Fee Reviews with the Pennsylvania Bureau of Workers’ Compensation for any disputes that cannot be resolved directly with the insurance company within the required timeframe.
• Timely and accurately documenting patient accounts in the medical provider system to reflect all updates and conversations with insurance companies.
• Following the guidelines established by the Health Insurance Portability and Accountability Act (HIPAA) for protecting sensitive health information.

Competency:

• Ability to learn new tasks and remember processes.
• Ability to maintain focus.
• Ability to complete tasks independently.
• Ability to assess the accuracy and thoroughness of the work assigned.
• Ability to regularly complete multiple time-sensitive tasks to meet required deadlines and productivity goals
• Ability to manage frequent disruptions and quickly return to task.
• High level of attention to detail
• Ability to make timely decisions in the context of a workflow.

Supervisory Responsibilities: None

Required Education and Experience:

• High school diploma or equivalent
• Prior experience working in an office setting.

Preferred/Desired Education and Experience:

• Prior experience as a Medical Claim Specialist or similar role.
• Understanding of Health Insurance Portability and Accountability Act (HIPAA) and Protected Health Information (PHI) guidelines.

Work environment:

This job operates in a hybrid home office/hospital office environment. This role routinely uses standard office equipment such as laptops, smartphones, photocopiers/scanners, postage equipment, shredders, and filing cabinets.

While performing the duties of this job, the employee is regularly required to sit, stand, or alternate between sitting and standing; communicate with others in person and by phone, fax, text, email, video; perform repetitive motions that may include the wrists, hands and/or fingers. The employee must occasionally lift and/or move up to 25 pounds.

Position type and expected hours of work: This is a full-time position. Typical work hours are 8:00am to 5:00pm, Monday through Friday. Overtime may be required as needed.

Travel: No travel is anticipated for this position.

Disclaimer

This job description is not designed to cover or contain a comprehensive list of activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change, or new ones may be assigned at any time with or without notice.