Job Description
Job Description
The Medical Claims Specialist reviews and analyzes denied claims received from payers (e.g., Medicare, Commercial and Third- Party). This position is responsible for handling the appeal of denied and/or unpaid medical insurance claims. Establish relationships with physicians’ offices through excellent customer service. The specialist manages a medium volume of 20-50 claims daily, utilizing standard industry software to support claims processing and coordination.
Responsibilities
- Responsible for favorable resolution of third-party payment denials, adverse determinations, medical necessity denials, payment discrepancies and contract misinterpretations to increase revenue for clients
- Submits of the required information to payers to establish medical necessity of unpaid medical insurance claims for the excimer laser with the corresponding Insurance Plan for the Company’s customers
- Provides claims and/or appeal letters based on current coding guidelines and clinical criteria as well as track and trend denial root causes for the specific coding denial/unpaid claim/appeal
- Identifies coding and clinical documentation issues and provide proactive recommendations to clients
- Identify problem accounts and escalate, as appropriate
- Update patient account records to identify actions taken on the account
- Responsible for preparing clear and concise audit reports
- Assist customers with reimbursement strategies and analyze and rectify complaints to provide suggested procedures and customized solutions to maximize payments
- Establish and maintain flow of required information relative to claim appeals with customer contacts and/or patients, including required claim support information and current claim status
- Execute all written correspondence within required time frames to Insurance Plans and conduct appropriate written and telephone contact and follow-up with Insurance Plans relative to claim appeals
- Track all customer activity in department databases and effectively maintain a current database of patient benefits, and the means to summarize the status and results, and report this information to management
- Comply with and adhere to the obligations of the Health Insurance Portability and Accountability Act (HIPAA) and all associated agreements entered by the Company
- Ensure compliance with parameters of Reimbursement Reassurance Program in addition to all company confidentiality rules and policies
Preferred Qualifications
- Working knowledge of Milliman Care preferred
- High school diploma plus 3 years experience in Medical Billing / AR / Appeals and/or Collections and appeals
- Knowledge of medical terminology and HIPAA regulations
- Effective communication skills - telephone, oral and written
- Strong investigative and problem-solving abilities
- Demonstrated competency in Microsoft Word and Excel and database applications, including proficient and accurate typing skills and using 10-key calculator.
- Strong attention to detail
Company DescriptionSTRATA Skin Sciences is a medical technology company dedicated to developing, commercializing and marketing innovative products for the in-office treatment of various dermatologic conditions such as psoriasis, vitiligo, and acne. Its products include the XTRAC® excimer laser, VTRAC® lamp systems, and the TheraClear®X Acne Therapy System.
Company Description
STRATA Skin Sciences is a medical technology company dedicated to developing, commercializing and marketing innovative products for the in-office treatment of various dermatologic conditions such as psoriasis, vitiligo, and acne. Its products include the XTRAC® excimer laser, VTRAC® lamp systems, and the TheraClear®X Acne Therapy System.