MedData has an excellent career opportunity available as a Claims Specialist - Appeals to work in a hospital setting located in the Medical Center in Houston, TX. The schedule for this full time role is Monday-Friday 7:30am- 4:30pm.
The purpose of this position is to review, submit and follow up on claims or medical bills for the Billing and Appeals Department. It is the primary responsibility of the Claims Specialist to ensure that claims are submitted timely, that they are processed accurately and, if required, denied services are appealed appropriately.
ESSENTIAL JOB FUNCTIONS:
- Review and research insurance claims to determine possible payment source(s)
- Contact various sources including insurance professionals, patients, and other parties to verify relevant data
- Coordinate with payors to ensure appropriate filing guidelines are met for reimbursement
- Request appropriate information, both verbally and written, from appropriate parties to ensure proper claim disposition
- Maintain and update payors on denied claims
- Ensure that appropriate billing guidelines and standards are met based on payor and/or State
- Perform aggressive follow up on unresolved claims and facilitate payment from appropriate payors
- Responsible for obtaining claim status and gathering supporting documentation to submit appeals
- Assist with written or verbal appeals to payors on denied claims
- Assist in defending the hospital’s or medical provider’s rights to recovery against insurance companies
- Interact with hospital staff members to obtain appropriate documentation for claims and appeals submission
- High School Diploma or GED, some college coursework preferred
- 1-2 years of related experience in the healthcare field or in a related area is preferred
- Ability to communicate effectively verbally and in writing and be able to speak professionally with patients and insurance companies
- Ability to proactively resolve issues
- Creative problem solving skills
- Ability to organize and set priorities according to situation all demands
- Required computer skills: must have experience with data entry and word processing, be capable of operating routine office equipment, possess a working knowledge of MS Office applications, and understand how to navigate through web-based applications
This job description is to serve as a guide but no way is it to be considered a comprehensive list of task, duties and responsibilities that will be required by the employee.
To join our team of 2,000 employees and growing, please visit apply directly to this posting.
MedData is an equal opportunity employer.
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