857 Medical Claims jobs in the United States

**TITLE: Medical Claims Specialist**
For those who want to keep growing, learning, and evolving. We at Kelly® hear you, and we're here for you! We're seeking a **DIRECT HIRE** Medical Claims Specialist to work at a company in Frankfort, KY (40601). Sound good? Take a closer look below. You owe it to yourself to consider this great new opportunity.
**Click APPLY to apply NOW! Or call Wendy at or email !**
**CANDIDATE REQUIREMENTS:**
+ DIRECT HIRE
+ Experience: Six (6) years of claims management experience or equivalent combination of education and experience require
+ Bachelor's degree from an accredited college or university preferred
+ Extensive knowledge of the Commercial General Liability policy
+ Significant experience in evaluating commercial liability coverages, preparing disclaimers and reservation of rights letters
+ Experience as a subject matter expert for commercial liability coverages
+ If candidate is an Attorney, then 5+years of relevant experience (OR) if candidate is an Examiner, then 10+years of relevant experience
**JOB DETAILS:**
+ $100k - $110k
+ DIRECT HIRE
+ Monday-Friday 8:30am-5pm
+ Remote
+ Negotiates claim settlement up to designated authority level
+ Analyzes and processes complex or technically difficult medical malpractice claims by investigating and gathering information to determine the exposure on the claim
+ Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions
+ Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines
+ Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement
**Click APPLY to apply NOW! Or call Wendy at or email !**
Related job titles: Claims Examiner, Claims Manager, Claims Supervisor, Claims Consultant
#P1
#CB
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Department: Outside Medical Services
Job Status: Full Time

FLSA Status: Exempt
Reports To: Director, Correctional Programs

Grade/Level:
Amount of Travel Required: 0 %

Work Schedule:
Positions Supervised: None

Generally, 8:00 a.m. to 5:00 p.m. with some flexibility for occasional additional hours.

* This is currently a hybrid - remote position for DFW applicants only and requires 2 days in office with 3 days from home. Executive management reserves the right to change this policy as company needs dictate in the future.

POSITION SUMMARY
The primary responsibility of the Medical Claims Specialist, is to support the day-to-day activities of the client and contracted medical providers by serving as the primary point of contact for operational support to these entities. This role is responsible for routine communication with clients regarding changes to the Provider Network, spending trends, claim inquiries, addressing operational issues, and researching payment information. The Medical Claims Specialist is responsible for overall client satisfaction and is expected to proactively identify, resolve and/or appropriately escalate any service issues.
ESSENTIAL FUNCTIONS
Reasonable Accommodations Statement
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable Accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.
Essential Functions Statement(s)

• Serve as Heritage's liaison with internal and external customers, to include: Heritage subcontractors, Customer Care Center (CCC), Contracting Department, and other internal functional units.
• Monitor and audit client authorization logs and documentation to stay within contract compliance requirements, ensure telephone, e-mail and faxes are addressed timely and forwarded to subcontractor(s) as appropriate, and ensure all inquiries are completed and closed.
• Monitor and audit content of information entered into Salesforce and other databases to ensure adequate documentation of events is recorded.
• Analyze data and create reports for clients
• Create and present quarterly business reviews to customers in person or via conference call.
• Coordinate implementation of new clients/customers/accounts - maintain a schedule of responsibilities within Salesforce
• Respond directly to inquiries from internal and external customers, orally or in writing, in a timely manner.
• Research, resolve and/or escalate program disputes.
• Communicate program information as needed to the Customer Care Center and assist that team in handling escalated client issues, or payment inquiries.
• Participate in staff meetings and conference calls.
• Communicate client changes and updates to appropriate internal departments.
• Create, organize and maintain client files.
• Ensure adherence to each client's contractual Statement of Work, and other contractual obligations as appropriate.
• Receive, document, process and forward all provider nomination inquiries to our provider networks department.
• Performs administrative functions as needed (copying, assembling binders, mailing, etc.).
• Perform other projects and responsibilities as requested
• Other job-related duties as assigned.

POSITION QUALIFICATIONS
Competency Statement(s)

• Accuracy/Quality - Accuracy looks at the extent to which an individual's work is correct and error free within company policies and guidelines. This competency asks the question "How well do you perform your work, and check the quality of the work before passing it along?"
• Decision Making - Decision making skills look at the ability of the individual to select an effective course of action while controlling resources and expenditures. The ability to make decisions and the quality and timeliness of those decisions. This competency asks the question "How well do you evaluate information and decide on an appropriate course of action?"
• Initiative and Creativity - Initiative looks at the ability of the individual to go ahead with a task without being told every detail. The ability to make constructive suggestions. This competency asks the question "How confident are you in making decisions on the basis of your own initiative?"
• Judgment - The skill of judgment looks at the ability of the individual to form sound opinions or make decisions by evaluating available information. This competency asks the question "How do you make decisions?"
• Project Management/Planning and Organizing - Project management skills looks at the ability of the individual to demonstrate an understanding of planning, organizing, staffing, directing, and controlling work tasks. The ability to analyze work, set goals, develop plans of action, utilize time. This competency asks the question "How well do you direct people and control deadlines to meet a specific goal?"
• Job Knowledge - Knowledge of job and policies/procedures that apply to one's job.
• Autonomy - Ability to work independently with minimal supervision.
• Communication, Oral - Ability to communicate effectively with others using the spoken word.
• Communication, Written - Ability to communicate in writing clearly and concisely.
• Detail Oriented - Ability to pay attention to the minute details of a project or task.
• Organized - Possessing the trait of being organized or following a systematic method of performing a task.
• Customer Oriented - Ability to take care of the customers' needs while following company procedures.
• Interpersonal - Ability to get along well with a variety of personalities and individuals.
• Tactful - Ability to show consideration for and maintain good relations with others.
• Active Listening - Ability to actively attend to, convey, and understand the comments and questions of others.

PREFERRED SKILLS & ABILITIES
Education: Bachelor's Degree preferred (four-year college or university) or four to six years of related experience.

Experience: One to three years' experience working in an Account Manager role preferred. Knowledge and understanding of Third-Party Administrator (TPA) role in managing medical claims processing is preferred. Experience working with, or for, Correctional Facilities is preferred. Minimum of two years' experience in an account manager role within the Health Care Insurance industries preferred.
Computer Skills: Microsoft Office Suite, including, Word, PowerPoint, and excellent Excel Skills, Microsoft Outlook, Internet, Salesforce
Certificates & Licenses:
Valid State issued driver's license

Additional Skills: Ability to fluently speak, read, and write in English.

Claims Specialist
Hours of work - M-F - 8-5 p.m.
Pay $20-23 per hour
REQUIRED: Must be able to obtain a DPS Level I fingerprint clearance upon offer.

Job Summary:
We are seeking a detail-oriented and experienced Medical Claims Specialist to join our growing team. The ideal candidate will have a strong understanding of CPT, ICD-10, and HCPCS codes and coding practices. If you have excellent organizational skills, attention to detail, and the ability to process claims efficiently, we would love to hear from you!

Job Responsibilities:

• Prepares all claims for billing, ensuring all claims are valid and authorized per the contracts. Includes running pre-billing reports to review for accuracy and running non-billable services report to ensure all billing is captured. Non-billable service reports should be communicated to Program Directors.
• Claims submission to Commercial plans, AHCCCS and Regional Behavioral Health Authority (RBHA), both contracted and non-contracted, for final resolution.
• Ensures accurate and timely filing.

• Reprocessing of denied claims with follow up to paid resolution/adjustment
• Recognizing and reporting trends
• Validates NPI/Tax ID
• Validates payor ID
• Departmental goal is to be under 120 days for file rejections and denied claims
• Works with EHR systems and Internal Departments
• COB/TLP claims processing
• Appeals and Grievances
• Self-pay plan review/billing
• Payment posting
• Ensures claim files are submitted accordingly. Submission should not exceed 30 days from initial service date or 60 days for claim rejections and/or denials
• Produces reports for internal and external customers and assists in the preparation of presentations for upper management and providers
• Attends meetings related to the claims system
• Completes required trainings
• Maintains current knowledge of Billing Rules and Guidelines.
• Create and maintain timely guidelines for all payers
• Knowledge of CPT, ICD-10, HCPC codes/coding
• All other duties as deemed necessary

Job Requirements:

• Education - HS/GED
• Certification - Certified Professional Coder or AAPC/AMA Certification preferred
• Experience -
• 5 years claims processing experience preferred.
• Behavioral Health billing experience preferred.
• Current, valid Arizona Driver's License, 39-month Motor Vehicle Report and proof of vehicle registration and liability coverage to meet insurance requirements.
• Must be able to obtain a DPS Level I fingerprint clearance card upon acceptance of offer
• First Aide, CPR certification (Employer provides)
• Initial current negative TB test result, within the prior 12 months. (Employer provides)

IND123

Job Description
Insight Global is looking for a Medical Claims Biller for one of our healthcare clients in Somerset, NJ. The candidate will oversee calculating and collecting payments for medical procedures and services. They will be submitting and following up on claims to ensure that they are fully reimbursed for the specific healthcare service provided. They must have experience following medical claims and updating patient data. The candidate should also understand and or have experience managing patients with Medicare and Medicaid insurance. They must be detail oriented and have great communication skills both written and verbal.
We are a company committed to creating inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity employer that believes everyone matters. Qualified candidates will receive consideration for employment opportunities without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, disability, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to Human Resources Request Form ( . The EEOC "Know Your Rights" Poster is available here ( .
To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: .
Skills and Requirements
-High School Degree, Associates or Bachelors degree preferred
-2-4 years billing and coding experience within healthcare industry
-Knowledgeable with submitting and following up on medical claims
-Experience calculating and collecting payments
-Strong customer service and communication skills -QuickBase experience null
We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal employment opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment without regard to race, color, ethnicity, religion,sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military oruniformed service member status, or any other status or characteristic protected by applicable laws, regulations, andordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or the recruiting process, please send a request to

**Job Title** : Medial Claims Processor
**Industry** : Healthcare
**FSLA status** : Non-Exempt
**Department** : Operations
**Level** : Entry to mid-level
**Location** : Work at Home
**Pay Rate: 17.00-18.00**
**In this Role the candidate will be responsible for:**
+ Processing of Professional and Hospital claim forms files by provider
+ Reviewing the policies and benefits
- Comply with company regulations regarding HIPAA, confidentiality, and PHI
- Abide with the timelines to complete compliance training of NTT Data/Client
- Work independently to research, review and act on the claims
- Prioritize work and adjudicate claims as per turnaround time/SLAs
- Ensure claims are adjudicated as per clients defined workflows, guidelines
- Sustaining and meeting the client productivity/quality targets to avoid penalties
- Maintaining and sustaining quality scores above 98.5% PA and 99.75% FA.
- Timely response and resolution of claims received via emails as priority work
- Correctly calculate claims payable amount using applicable methodology/ fee schedule/
**Required Skills for this role include:**
+ 2+ year(s) of Medical Claims experience
+ 2+ year(s) using a computer with Windows applications that required you to use a keyboard, navigate multiple screens and computer systems, and learn new software tools
+ 1+ years of working with Claims Adjudication Systems
+ High School diploma or equivalent
**Preference**
+ Ability to communicate (oral/written) effectively in a professional office setting
+ Effective troubleshooting skills where you can leverage your research, analysis and problem-solving skills
+ Time management skills that require the ability to cope with a complex, changing environment
Where required by law, NTT DATA provides a reasonable range of compensation for specific roles. The starting hourly range for this remote role is **$17.00-18.00.** This range reflects the minimum and maximum target compensation for the position across all US locations. Actual compensation will depend on several factors, including the candidate's actual work location, relevant experience, technical skills, and other qualifications. This position may also be eligible for incentive compensation based on individual and/or company performance.
This position is eligible for company benefits that will depend on the nature of the role offered. Company benefits may include medical, dental, and vision insurance, flexible spending or health savings account, life, and AD&D insurance, short-and long-term disability coverage, paid time off, employee assistance, participation in a 401k program with company match, and additional voluntary or legally required benefits _._
**_#INDHRS_**

Job Description

Job Description

Description:

As a Medical Claims Adjuster with Wilson-McShane Corporation, you will be processing medical, and short-term disability claims. This position has direct impact on the participants and families of the plans we administer by ensuring their claims are processed timely and accurately. Our Claims Adjusters also answer a high-volume of phone calls. This provides the opportunity to speak with participants and providers directly via phone and in person in order to best support them with their claims and benefit questions.

The schedule for this position is 8:00am-5:00pm, Monday-Friday with a 1 hour lunch. This is a non-exempt position with a compensation of $23.00 per hour.

The Claims Adjuster position is a non-exempt position and includes benefits such as the following:

• Low Deductible Health, Prescription Drug and Dental Benefits
• Voluntary Vision, Accident, Critical Illness and Pet Insurance
• 401(k) and Roth 401(k)
• Paid Holidays and Paid time off
• Employee Assistance Program, including access to confidential counseling (virtual and in-person)

Essential Skills and Qualifications:

• Minimum of two years claims paying experience required.
• Ability to read and interpret documents such as Summary Plan Description and procedure manuals.
• Computer Skills: Proficiency with Microsoft Office. Quick learner of other computer applications.

If you enjoy utilizing attention to detail to process claims and providing excellent customer service as you assist people with their claims process, please consider applying today!

Requirements:

Job Description

Job Description

Description:

As a Medical Claims Adjuster with Wilson-McShane Corporation, you will be processing medical, and short-term disability claims. This position has direct impact on the participants and families of the plans we administer by ensuring their claims are processed timely and accurately. Our Claims Adjusters also answer a high-volume of phone calls. This provides the opportunity to speak with participants and providers directly via phone and in person in order to best support them with their claims and benefit questions.

The schedule for this position is 8:00am-5:00pm, Monday-Friday with a 1 hour lunch. This role is a non-exempt position with compensation at $27.50 per hour and includes benefits such as the following:

• Low Deductible Health, Prescription Drug and Dental Benefits
• Voluntary Vision, Accident, Critical Illness and Pet Insurance
• Flexible Spending Account (FSA)
• Employer Contribution to 401(k)-No Match Required
• 401(k) and Roth 401(k)
• Paid Holidays and Paid time off
• Dependent Care Reimbursement Account
• Life Insurance and AD&D
• Employer Paid Short Term Disability
• Employee Assistance Program, including access to confidential counseling (virtual and in-person)

Essential Skills and Qualifications:

• Minimum of two years claims paying experience required.
• Ability to read and interpret documents such as Summary Plan Description and procedure manuals.
• Computer Skills: Proficiency with Microsoft Office. Quick learner of other computer applications.

If you enjoy utilizing attention to detail to process claims and providing excellent customer service as you assist people with their claims process, please consider applying today!

Requirements:

Job Description

Job Description

Centerprise Inc. is seeking to hire a Medical Claims Specialist to join our team.

JOB SUMMARY:

The Medical Claims Specialist performs a variety of billing and administrative tasks including claim submission, claim correction, insurance follow-up and appeals and insurance verification. They will also assist with all other billing and finance duties as needed.

ABOUT THE COMPANY:

Centerprise is a professional services organization providing consulting and Revenue Cycle Management services to Federally Qualified Health Centers (FQHCs). We are located outside Cincinnati, Ohio, and conduct business nationally.

Centerprise is a company on the rise! We are very excited to say that we currently employ 25 staff members, and we are steadily growing! We take great pride in focusing on employee satisfaction. Happy employees; means happy customers!

At Centerprise we offer our clients a wide variety of services, therefore, we require a large range of skill sets within our company. We would love to hear from dynamic individuals who are seeking an opportunity to grow their skills in an upbeat, fast paced, and team-based environment.

Centerprise has a small company feel, with larger company resources. Please refer to our website for more information,

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Follow-up: Regularly monitor patient account insurance balances to ensure timely payment and resolve any outstanding issues.
• Payer Communication: Contact payers regarding payment status, resolve incorrect payment issues, and ensure proper reimbursement.
• Denial Management: Work closely with leadership to address and resolve any denied claims promptly.
• Understanding Guidelines: Stay informed about both government and non-government contractual billing and follow-up guidelines, ensuring compliance with individual payer requirements.
• Payment Resolution: Address issues related to lack of payment or improper payment by government, non-government, and self-payers, ensuring that all incorrect payment issues are resolved promptly.

QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty completely. The requirements listed below are representative of the knowledge skill and/or ability required.

Minimum Qualifications:

• High School Diploma or Equivalent (GED), associate degree preferred.
• Medical billing experience required. FQHC billing experience is a plus.
• Proficiency with Microsoft Office Suite. Must be able to use Excel spreadsheets.
• Knowledge of Medical Terminology, CPT and ICD-10 Coding, Electronic Billing, and HIPPA
• EHR Experience in required. Preferred experience with NextGen or eClinicalWorks
• Excellent written and oral communication skills

Pay: $18-$0/hour based on experience

Benefits:

• Competitive benefits package, including options to enroll in the following programs: Health, Dental, Vision, Life, Short Term Disability, Long Term Disability, Flex Savings Accounts
• 401 (k) Program with competitive company match
• Courtesy Plan, full time staff and their immediate family members are eligible for courtesy treatment at any HealthSource of Ohio office up to 500.00 per family
• PTO and Long-Term Sick Bank, full time employees earn up to 25 days per year in first calendar year: 15 days of Paid Time Off (PTO), and 10 days of Long-Term Sick Bank (LTSB)
• Credit Union Privileges, Sharefax Credit Union
• Quarterly Bonus Incentive Program

Schedule:

• Monday to Friday; no evenings, or weekends
• After training may be eligible to work a hybrid-remote schedule which will include 2-3 in office days per week.

Work Location: Loveland, OH 45140. Must be able to commute or planning to relocate before starting work.

Centerprise Inc. is an Equal Opportunity/Affirmative Action Employer:

Minority/Female/Disabled/Veteran