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OOS Claims Specialist

OOS Claims Specialist

Job ID 
Out Of State

More information about this job

About The Company

MedData, a MEDNAX (NYSE: MD) company, is a technology-enabled services organization that improves financial outcomes for hospitals by enhancing the patient experience and expanding their access to healthcare. The MedData managed services program includes a range of patient access and communications, revenue cycle management, and consulting and analytics solutions for healthcare systems, including billing, coding, patient balances, eligibility and enrollment, third party liability, and mobile apps.
At MedData, we take great pride in our company, in each other, and in our 30+ year history of accomplishments and success. This pride is reflected in our everyday approach to working together. Each team member understands the importance of being part of a company that values their individual contributions and strives to help them achieve their personal goals as they work together to achieve the broader corporate goals. We believe that every team member contributes directly to MedData’s growth and success, and we are constantly searching for new talented, passionate and enthusiastic people who will take pride in being an integral part of our culture.

Job Description

MedData has an excellent career opportunity available as a Claims Specialist - Out of State to work in a hospital setting located in Houston, TX. The schedule for this full time role is Monday-Friday 8am-5pm. As the Claims Specialist you will be splitting your time between two different hospitals in the Houston area. 




The purpose of this position is responsible for investigating, facilitating and coordinating benefits for Medicaid and Medicare insurance policies.



  • Facilitate billing processes and securing necessary documentation.
  • Complete & submit forms and additional documents as needed.
  • Maintain case notation & update all applicable systems.
  • Strong multi-tasking abilities including juggling multiple operating systems
  • Monitor status of each case while communicating effectively with multiple parties.
  • Coordinate with appropriate client personnel to ensure appropriate filing guidelines are met for reimbursement.
  • Maintain and update proper account documentation.
  • Verify information obtained from patients and medical providers regarding insurance coverage with insurance companies for accuracy at the time of service and perform initial authorization requirements prior to discharge from facility
  • Complete and follow up of authorization for services rendered after discharge from facility.
  • Formulate and submit appeals on authorization requests that have denied
  • Obtain bills and medical records from medical providers and send them to insurance companies for processing, in compliance with HIPAA and FDCPA standards.
  • Edit electronic and hard copy claims for submission to various insurance carriers including government, managed care and commercial.
  • Process requests with appropriate information, both verbally and written, from appropriate parties to ensure proper claim disposition.
  • Perform aggressive follow-up on unresolved claims and facilitates payment form appropriate payers.
  • Research account details and formulate appeal letter or disputes to various insurance carriers including government, managed care and commercial. 


  • High School Diploma or GED
  • Working knowledge of ICD9, CPT codes, HIPAA, HCPCS and Medicaid preferred
  • 1-3 years of related experience in the field or in a related area
  • Excellent verbal and written communication skills,
  • Critical thinking and strong attention to detail.
  • 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 apply directly to this posting.

MedData is an equal opportunity employer.