The Medical Insurance Specialist is responsible for coordinating patient and insurance billing, meeting accuracy, compliance, and productivity standards. Reviews all claims to assure proper documentation, prior authorization, and patient eligibility are met to achieve successful payment of claims while providing exceptional customer service to patients, business partners, and customers.
5+ years of experience working unpaid accounts and contacting carriers for follow-up on denied claims.
Must understand appeals process for Medicare, Medicaid and commercial carriers, must understand CPT and ICD-10 and modifier usage and understand basic medical necessity.
Must be able to communicate properly with carriers to resolve unpaid claims.