Medical Billing Specialist responsible for creating and sending insurance claims and patient statements for Pediatric Home Service. Analyzing payments, contacting patients, and utilizing billing systems for efficient service delivery.
EX
Hybrid Executive – Claims Management, Medical Billing and Claims Processing
Posted 4 weeks ago
About the role
- Claims Analyst responsible for repricing non-par claims per Fee schedule and conducting reviews of medical claims for correct reimbursement calculations.
Responsibilities
- Responsible to reprice the non-par claims as per the Fee schedule and payment methodology.
- Conduct primary and secondary reviews of medical claims to verify correct reimbursement calculations based on costs, Medicare, or a usual and customary methodology in accordance with self-funded benefit plan language.
- Use Microsoft Office products to generate letters, explanations, and reports to explain medical reimbursement approaches and communicate this information.
- Provide input for new process development and continuous improvement.
- Supplier will share daily production report with stateside manager for review and feedback.
- Maestro Health will provide all applications and accesses required for claim repricing.
- Access requests should be completed within first week of project start date in order to start production.
Requirements
- Graduate in stream preferred science stream 1 - 2 Years
- Expertise in using Claim processing and validation application and worked in past on same profile/portfolio.
- Basic level proficiency on Excel to query production data and prepare/generate reports.
- Analytical mindset with strong problem solving skills.
- US Healthcare insurance domain experience desirable
- Understanding of US Healthcare system terminology, understanding of claims, complaints, appeals and grievance processes.
Benefits
- Software/System licensing will be charged to the cost center directly vs. invoiced by Supplier.
- Requirement gathering & training session will require active participation from Maestro Health manager.
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
Medical Billing Specialist responsible for creating and managing insurance claims in pediatric home health care. Collaborating with insurance companies and patients for billing resolutions.
Instructor facilitating learning of course competencies in medical coding and billing. Supports student success through excellent instruction and engagement in the learning process.
Medical Billing Coordinator managing patient financial services at Boston IVF in Waltham, MA. Supervising team personnel and ensuring account accuracy and compliance with financial policies.
Certified Coding Specialist analyzing clinical information and assigning ICD - 10 codes at INTEGRIS Health. Ensures compliance with guidelines and assists in coding process for health records.
Medical coder advising clients on SwissDRG regulations and managing business operations for Swiss clients. Requires medical coding certification and fluency in French plus additional languages.
Medical Billing Team Lead at Dr.Bill managing billing operations in Manitoba and Saskatchewan. Providing exceptional service and maintaining accurate customer account records and claims processing.
Medical Coding Education Associate analyzing claims data and collaborating with providers on coding standards. Ensuring accuracy of code assignment and educational support through feedback and analysis.
Medical Coding Education Associate Sr conducting claims data analysis for Elevance Health. Engaging with providers to ensure accurate coding and documentation guidelines with hybrid work requirements.
Home health coder for Banner Health evaluating medical records and assigning diagnosis and procedure codes. Working with medical providers for accurate coding compliance and quality assurance.