MedData has an excellent career opportunity available as a Claims Specialist - Out of State to work in an office setting located in Houston, Texas. The schedule for this Full Time role is split between two facitlies.
The purpose of this position is responsible for investigating, facilitating and coordinating benefits for Medicaid and Medicare insurance policies.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- 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.
QUALIFICATIONS AND REQUIREMENTS
- 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
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is frequently required to sit; use hands to finger, handle, or feel; and reach with hands and arms. The employee is occasionally required to stand and walk and must occasionally lift and/or move up to 25 pounds.
The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or a logical assignment to the position.
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