Medical Claims Specialist

US-PA-Chadds Ford
5 days ago(1/12/2018 2:32 PM)
Job ID
Medical Claims Specialist


The Medical Claims Specialist has overall responsibility for verifying patient insurance, submitting claims to insurance companies, collecting payment from patients, posting payments from individuals and insurance companies, keeping track of payments and outstanding balances, troubleshooting unpaid claims, presenting reports to management, and communicating with clients and patients.


  • Provides consultation to customers regarding insurance coverage
  • Works with insurance companies to verify eligibility
  • Confirms referrals and/or authorizations are in place when required by insurance company; if not, helps patient get referral and/or authorization
  • Ensures insurance companies are contacted to complete the verification process through phone calls and/or web based sites
  • Obtains authorizations/ pre-certifications from insurance companies or from clients for out of network insurers
  • Documents the insurance and authorization verification information in the applicable computer system(s) in accordance with documented work processes; Ensures any coverage restrictions are documented and addressed to avoid payment problems
  • Develop and maintain adequate, current knowledge of various insurance requirements (medical necessity, eligibility, referral, authorization, pre-certification, etc.) and policies for all types of hearing aid benefits and various appointment types; respond to insurance calls accordingly
  • Oversees overall patient account management
  • Assists in resolution of edits in electronic charge captures as well as claim edits
  • Serves as a resource to clients with regard to insurance billing, authorization and insurance resolution issues
  • Works with insurance companies to monitor claim status, pursue and dispute claim denials, elevate claims to appeals, and/or seek all methods to resolve open claims
  • Review denied insurance claims, gather and submit information needed for an appeal
  • Maintains accounts receivable aging reports and constantly reviews and resolves past due, credit and debit balances
  • Reconcile and post payments from insurance companies
  • Maintains strict confidentiality of all protected health information (PHI) and adheres to HIPAA guidelines and AHAA’s policies and procedures related to release of information and patient records access
  • Performs other related duties, which may be inclusive, but not listed in the job description




  • High School Diploma or equivalent required, Bachelor’s Degree a plus


  • Minimum of two years’ experience working with insurance verification and denial claims in healthcare billing or managed care; minimum 3 years administrative experience
  • Familiarity with ICD 10, CPT codes, and medical billing procedures
  • Experience working with clients on medical account collections
  • Working in an Audiology or ENT facility a plus


  • Knowledge of healthcare insurance industry rules and regulations
  • Excellent problem solving skills, individually and as part of a team
  • Exceptional organizational skills and attention to detail
  • Very strong computer skills, including word processing, email, calendars, spreadsheets, web-based applications and internet searches
  • Excellent interpersonal and customer service skills, by phone, by email, and in person.
  • Strong command of English language and grammar and the ability to communicate clearly in English in writing, by phone, and in person.
  • Ability to prioritize and follow through on a large number of tasks ranging from immediate to long-term and from independent to collaborative.



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