Medical Claims Specialist (Henderson)

Henderson Health Care, Inc.; Henderson (NE); Vor Ort; USD 40.000 - 64.000; Vollzeit

Benefits dieser Stelle

Competitive salary

Hire-on bonus up to $7,500

Zusammenfassung

Henderson Health Care, Inc. in Nebraska seeks a Medical Claims Specialist to ensure accurate submission, follow-up, and resolution of denied claims.

You will post charges, reconcile accounts, and maintain patient financial records while adhering to billing regulations. You will coordinate with providers, patients, and third-party payers, review documentation for CPT/ICD coding, stay compliant with Medicare and state/federal rules, and participate in audits and monthly close.

Qualifikationen

• Experience in medical claims processing and billing workflows.
• Familiarity with CPT/ICD coding and payer guidelines.
• Ability to review documentation for accuracy and compliance.

Aufgaben

• Process medical claims for submission to patients and third-party payers.
• Review medical records to support billing accuracy and compliance.
• Post charges and reconcile accounts in billing system.
• Follow up on denied or rejected claims and resolve issues.
• Monitor aging accounts receivable and support monthly close procedures.
• Ensure HIPAA compliance and maintain patient confidentiality.

Kenntnisse

Medical billing

CPT coding

ICD coding

HIPAA compliance

Accounts receivable

Payer communication

Tools

Billing software

Claims submission systems

Jobbeschreibung

The Medical Claims Specialist is responsible for the accurate and timely processing of medical claims, including submission, follow-up, and resolution of denied or rejected claims. This role involves charge posting, reconciliation, maintaining patient financial records, and ensuring compliance with billing regulations and payer requirements. The specialist serves as a key liaison between providers, patients, and third-party payers.

ESSENTIAL DUTIES AND RESPONSIBILITIES

BILLING AND CLAIMS MANAGEMENT

• Ensure accurate and efficient processing of medical claims for submission to patients and third-party payers.
• Review and verify medical record documentation to support compliant billing practices.
• Submit claims electronically or manually, and follow up promptly on denied or rejected claims to resolve issues.
• Maintain knowledge of current medical billing practices, CPT/ICD coding, and billing compliance requirements.
• Post charges, perform account reconciliations, and support monthly audit and close-out procedures.
• Monitor aged accounts receivable and perform follow-up on unpaid claims in accordance with organizational policies.
• Research and resolve any billing discrepancies or delays in payment, including insurance underpayments and denials.
• Process adjustments, corrections, and refunds in alignment with policy and payer guidelines.
• Maintain the integrity and accuracy of patient financial files in the billing system.

INSURANCE COORDINATION AND REIMBURSEMENT

• Coordinate with insurance carriers to ensure proper billing and reimbursement.
• Review and interpret payer contracts and per diem agreements to ensure accurate payments.
• Stay up to date with changes in payer regulations, reimbursement policies, and federal/state billing requirements.
• Ensure compliance with Medicare and other regulatory billing standards.
• Respond to inquiries from insurance companies, patients, and providers regarding account status and billing questions.

QUALITY AND COMPLIANCE

• Participate in internal audits and monthly close processes to ensure billing accuracy.
• Examine work for accuracy, completeness, and compliance with established policies and procedures.
• Maintain confidentiality of all patient and organizational information in accordance with HIPAA and internal policies.
• Support quality improvement initiatives and assist with departmental reporting and monitoring activities.
• Contribute to the training and orientation of new employees as assigned.

Additional Benefits

• Competitive salary and comprehensive benefits package.
• Up to a $7,500 hire-on bonus.

"Had to place my mother in law and a residential care setting. This process was very stressful on my family, but the staff at Henderson Health Care and Legacy Square made everything run smoothly. We are all happy with the move and care that she is receiving."