Senior Claims Specialist Job in Worcester 01608, Massachusetts Us

SENIOR MEDICAL BILLING CLAIMS SPECIALIST

 

An established, fast paced and growing medical billing and practice management firm located in downtown Worcester, is seeking a top-notch physician billing Senior Medical Billing Claims Specialist to join our Denial Prevention team.

The primary role of the Senior Claims Specialist is to use their extensive technical expertise in physician multi-practice claims resolution in a proactive manner to prevent future claim denials in our new web-based billing software.  Must be able to “see the forest through the trees”.  Through their work in resolving current claim denials to minimize accounts receivables for our clients, they will effectively communicate to the product development team the required changes in upfront claim preparation that will assure a compliant denial rate. Requires strong analytical skills and excellent communication skills.  Advanced Excel skills a must.  Competitive salary.

 

Summary of Essential Responsibilities

·         Technical Analysis for Denial Prevention. Use an analytical eye to determine specific reasons for claim denials, and clearly communicate the required changes in up front claim preparation to product development team that will assure compliant denial rates of less than 2% with contract carriers and 5% with non-participating carriers.

·         Ownership of Receivables.  Manage client accounts receivable in aggregate for several physician practice clients, performing all functions efficiently, accurately and proactively.   This entails processing insurance reimbursements, and working claims rejections, remaining balances, credits, and 60 plus, as well as processing Aged Trial Balances and Days Aged Reports. 

·         Continuous Improvement.  Possess a high degree of professionalism, self-motivation, and analytical skills to help advance the company’s initiatives, and update, prepare and analyze information for executive and client reporting purposes.  Ensure compliance to HIPAA and other regulatory requirements. 

 

Minimum requirements

·         College Degree. 

·         Must have five to seven years of MA/CT physician medical billing experience involving complex surgical procedures and multi-disciplinary specialties; experience with additional states beneficial.  Practice management experience a plus.

·         Strong knowledge of billing and reimbursement practices and requirements of Medicare Part B, Medicaid and all major HMO/insurance carriers, and their available resources. 

·         Knowledge of medical terminology, anatomy, physiology and disease processes.

·         Advanced working knowledge of CPT, ICD-9, HCPCS, and anesthesia coding and modifier assignment.  Physician coding certification a plus.

·         Self-motivated, service oriented and strong communication skills on the phone, in writing and in person. 

·         Strong analytical and interpersonal skills and the ability to work well and adapt to change in a fast-paced team environment.

·         Proficient in Excel a must.  Working knowledge of MS Office and Adobe Acrobat applications, and able to easily learn new systems.

 

Qualified candidates only, kindly forward a cover letter highlighting your key qualifications and salary requirements along with your resume. We offer health and dental insurance, a 401K program with a match, parking reimbursement, sick, personal, and vacation time, long term disability and life insurance.