Job Summary
We are seeking a proactive and detail-oriented Aged and Denied Claims Specialist to join our dynamic healthcare claims team. In this vital role, you will be responsible for managing and resolving outstanding and denied medical claims, ensuring accuracy and compliance throughout the process. Your expertise will help streamline claims recovery efforts, improve cash flow, and enhance overall patient satisfaction. If you thrive in a fast-paced environment, possess strong analytical skills, and are passionate about healthcare billing and coding, this opportunity is perfect for you!
Duties
- Review and analyze aged claims to identify reasons for delays or denials, prioritizing cases based on urgency and potential recovery value
- Investigate denied claims by thoroughly examining medical records, billing documentation, and coding details such as DRG (Diagnosis-Related Group), CPT (Current Procedural Terminology) codes, ICD-9, and ICD-10 classifications
- Collaborate with healthcare providers, insurance companies, and internal teams to gather missing information or clarify discrepancies in medical records and billing data
- Re-submit corrected claims with appropriate documentation to facilitate successful reimbursement
- Maintain detailed logs of claim statuses, follow-up actions, and outcomes within electronic health record (EHR) systems or enterprise resource planning (ERP) platforms
- Stay updated on evolving medical coding standards, insurance policies, and regulatory requirements to ensure compliance during all claim processing activities
- Provide exceptional customer service by communicating effectively with payers and internal stakeholders regarding claim statuses or resolution strategies
Experience
- Proven experience in medical billing, coding (including DRG, CPT coding, ICD-9/10), or healthcare claims management
- Strong understanding of medical terminology, medical records management, and insurance claim processes
- Familiarity with EMR (Electronic Medical Records) systems and EHR (Electronic Health Records) platforms used in healthcare settings; EDI a plus
- Knowledge of medical collection procedures and effective dispute resolution techniques
- Prior work experience handling denied or aged claims in a fast-paced environment is highly preferred
- Excellent attention to detail combined with analytical problem-solving skills to identify root causes of claim issues
- Ability to adapt quickly to changing regulations and maintain compliance standards in all claim activities
Join us to make a meaningful impact by ensuring healthcare providers receive rightful reimbursement while delivering excellent service. We’re committed to supporting your professional growth as you contribute to our mission of delivering outstanding healthcare administration!
Pay: $17.00 - $20.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Retirement plan
- Vision insurance
Work Location: In person
