Robert Half Finance & Accounting Contract Talent is currently seeking a highly skilled Healthcare Claims Processor to join our client's team.<br><br>Opportunity Overview:<br>We are in search of a detail-oriented Healthcare Claims Processor with a strong background in healthcare AR follow-up, insurance claim collection, and claims processing. This role is critical in understanding the complexities of claim denials, drafting appeal letters, and ensuring the reimbursement process operates smoothly. The position demands a commitment of 40 hours per week.<br><br>Key ResponsibIlities:<br>Conduct thorough healthcare AR follow-up, focusing on prompt reimbursement.<br>Skillfully handle the collection of insurance claims, ensuring accuracy and completeness.<br>Execute comprehensive claims processing, proactively addressing potential denial factors.<br>Demonstrate expertise in identifying and resolving issues leading to claim denials.<br>Draft persuasive appeal letters to challenge and rectify denied claims.<br>Stay informed about industry changes and insurance regulations affecting claims processing.<br><br>Qualifications:<br>Proven experience in healthcare claims processing, with a deep understanding of industry best practices.<br>Proficient knowledge of insurance claim collection procedures.<br>Familiarity with the intricacies of claim denial factors and effective resolution strategies.<br>Exceptional skills in drafting compelling appeal letters.<br>Available to commence work in March with a commitment of 40 hours per week.<br><br>Additional Details:<br>Familiarity with relevant healthcare coding systems is preferred.<br>Ability to navigate and utilize healthcare information systems effectively.<br>Understanding of healthcare compliance regulations and privacy laws.<br>Strong analytical skills to identify patterns and trends in claim denials.<br>Collaborative approach to work, ensuring seamless coordination with other healthcare professionals.<br><br>To express your interest in this role or to obtain further information, please reach out to us directly at (314) 262-4344. We are eager to discuss this exciting opportunity with you.
<p>Robert Half is working with a reputable health care organization that is seeking a detail-oriented and motivated Accounts Receivable/Medical Insurance Follow-Up Specialist to join their finance team. This position is a contract-to-hire role in the Danville, Kentucky area. The ideal candidate will have a background in medical billing and insurance claims processing, with the ability to effectively communicate with insurance companies, patients, and internal departments to resolve outstanding accounts. If you do not have that exact experience, but have transferable skills and would like to jumpstart a career in healthcare, please feel free to apply today! </p><p> </p><p>Responsibilities:</p><ol><li>Review and analyze unpaid claims to determine appropriate action for resolution.</li><li>Conduct follow-up with insurance companies to ensure timely payment and resolve any discrepancies.</li><li>Investigate and appeal denied or rejected claims, providing necessary documentation and information as required.</li><li>Work closely with billing and coding staff to ensure accurate and compliant claims submission.</li><li>Verify insurance eligibility and coverage for patients, obtaining pre-authorizations and referrals as needed.</li><li>Monitor accounts receivable aging reports and prioritize collection efforts based on account status and aging.</li><li>Collaborate with patients to resolve outstanding balances, establish payment plans, and provide financial counseling when necessary.</li><li>Maintain accurate documentation of all interactions and correspondence related to accounts receivable and insurance follow-up.</li><li>Stay informed of changes in healthcare regulations and insurance policies to ensure compliance and maximize reimbursement.</li></ol><p><br></p>
We are looking for a detail-oriented Medical Billing Insurance Clerk to join our team on a contract basis in Barton, Vermont. In this role, you will play a critical part in ensuring accurate billing and claim administration while maintaining confidentiality and compliance with regulations. This position is ideal for someone with a strong understanding of medical billing processes and experience working with insurance claims.<br><br>Responsibilities:<br>• Process and submit medical claims to insurance providers, ensuring accuracy and compliance with established guidelines.<br>• Utilize billing software to manage data entry and track claim statuses.<br>• Verify insurance coverage details and resolve claim discrepancies efficiently.<br>• Handle collections and follow up on outstanding payments from insurance providers.<br>• Maintain confidentiality of patient information and billing records.<br>• Collaborate with team members to ensure seamless operations and timely claim submissions.<br>• Generate and analyze reports related to billing and insurance claims.<br>• Manage Medicaid and commercial insurance billing processes, adhering to specific regulations.<br>• Update and maintain spreadsheets for tracking billing activities and payment records.<br>• Communicate effectively with insurance companies and healthcare providers to address billing concerns.
We are looking for a dedicated Medical Claims Analyst to join our healthcare team in Minneapolis, Minnesota. In this long-term contract position, you will play a vital role in processing leave of absence claims, ensuring compliance with medical certifications, and calculating benefit allocations. This is an excellent opportunity to contribute to a fast-paced industry while leveraging your expertise in medical claims and benefits administration.<br><br>Responsibilities:<br>• Process and manage leave of absence claims by coordinating medical certifications and ensuring timely submissions.<br>• Calculate benefit amounts, including allocations from corporate and state sources, to ensure accurate disbursements.<br>• Review, approve, or deny claims based on established guidelines and medical documentation.<br>• Utilize systems such as ServiceNow and Workday to track, manage, and process claims efficiently.<br>• Maintain detailed records of claims and benefits to ensure compliance and accuracy.<br>• Communicate with healthcare providers to confirm certifications and resolve discrepancies.<br>• Address rejected claims by investigating issues and providing resolutions.<br>• Collaborate with team members to streamline leave administration processes.<br>• Provide guidance to employees regarding medical leave policies and benefits.<br>• Stay updated on state and federal regulations related to leave and benefits administration.
<p>We are looking for a detail-oriented Medical Billing Specialist to join our team on a contract basis in Fayetteville, North Carolina. In this role, you will be responsible for ensuring accurate billing processes and maintaining compliance with healthcare regulations. This position requires a strong understanding of medical billing practices and excellent organizational skills.</p><p><br></p><p>Responsibilities:</p><p>• Review and process medical claims with accuracy and attention to detail.</p><p>• Verify patient information and insurance coverage to ensure proper billing.</p><p>• Resolve discrepancies and follow up on denied claims to maximize reimbursement.</p><p>• Maintain compliance with state and federal healthcare billing regulations.</p><p>• Collaborate with healthcare providers and administrative staff to streamline billing operations.</p><p>• Generate and analyze billing reports to identify trends and areas for improvement.</p><p>• Handle inquiries from patients and insurance companies regarding billing issues.</p><p>• Stay updated on industry changes and updates to billing codes and procedures.</p><p>• Assist with audits and ensure documentation is complete and accurate.</p><p>• Support the implementation of new billing systems as needed.</p>
We are looking for a detail-oriented Medical Billing Specialist to join our team on a long-term contract basis. In this role, you will play a critical part in ensuring accurate and timely processing of medical billing and claims for a healthcare facility in Raeford, North Carolina. This position offers the opportunity to contribute to the smooth financial operations of a trusted healthcare provider.<br><br>Responsibilities:<br>• Prepare, review, and submit medical claims to insurance companies, ensuring accuracy and compliance with regulations.<br>• Follow up on outstanding claims and resolve any issues or discrepancies promptly.<br>• Verify patient insurance coverage and eligibility to facilitate proper billing.<br>• Maintain detailed records of billing activities and ensure confidentiality of sensitive information.<br>• Collaborate with healthcare providers and administrative staff to clarify billing details and address concerns.<br>• Monitor and analyze billing trends to identify opportunities for process improvements.<br>• Respond to patient inquiries regarding billing statements and insurance claims.<br>• Ensure compliance with all relevant healthcare and billing laws, regulations, and guidelines.<br>• Assist in generating financial reports related to billing and collections.
We are looking for a skilled Medical Billing Specialist to join our team in Rochester, New York. In this critical role, you will contribute to the healthcare revenue cycle by ensuring accurate billing, timely claim submissions, and efficient payment processing. This is a Contract-to-Permanent position, offering an opportunity to grow within the organization while supporting essential billing operations.<br><br>Responsibilities:<br>• Prepare, review, and submit accurate insurance claims in alignment with established deadlines.<br>• Process payments received from patients and insurance providers, ensuring timely updates to financial records.<br>• Follow up on unpaid claims, resolve discrepancies, and maintain account accuracy.<br>• Communicate professionally with patients to address billing inquiries, statements, and payment plans.<br>• Organize and maintain patient records, payment histories, and other billing-related documentation in compliance with healthcare regulations.<br>• Coordinate with insurance providers to clarify coverage details and resolve reimbursement issues.<br>• Stay informed on healthcare billing codes, industry standards, and policy updates to ensure compliance in all billing activities.
<p>We are looking for a detail-oriented Medical Revenue Cycle Associate to join our team our team in Los Angeles, California. The Medical Revenue Cycle Associate will play a critical part in optimizing the medical billing and collections process within the healthcare industry. Your expertise will help ensure claims are processed efficiently and payments are collected accurately.</p><p><br></p><p>Responsibilities:</p><p>• Review submitted claims to verify accuracy and completeness before forwarding them to the appropriate payer.</p><p>• Medical Insurance collections and denials management.</p><p>• Analyze denial information and correspondence to identify reasons for unpaid claims, taking action to resolve issues and resubmit claims promptly.</p><p>• Investigate patient accounts and payment records to confirm proper billing and rectify discrepancies, adjusting balances as necessary.</p><p>• Prepare and submit corrections or appeals for rejected claims, adhering to payer-specific guidelines and including all required documentation.</p><p>• Process adjustments for charges that cannot be billed, ensuring compliance with established adjustment protocols.</p><p>• Verify that required authorizations, TARs/SARs, are included in claim submissions, and take steps to secure missing authorizations when needed.</p><p>• Maintain productivity and quality standards by consistently meeting deadlines and accuracy requirements.</p><p>• Collaborate with team members and supervisors to address complex billing issues and improve workflows.</p>
<p>If you’ve ever wanted to combine your administrative skills with the chance to truly make an impact in people’s lives, this opportunity is for you. Our client, a growing <strong>medical services provider in San Marcos</strong>, is seeking a <strong>Customer Service Representative</strong> who will provide compassionate, efficient, and professional support to patients, families, and providers. Healthcare is fast-paced, complex, and often stressful for the people navigating it. Patients rely on a system that is not always easy to understand — insurance claims, authorizations, billing, and appointment scheduling can quickly become overwhelming. That’s why this role is so critical: as a Customer Service Representative, you’ll act as both guide and advocate, helping patients get the answers they need and ensuring they feel cared for from the very first call.</p><p><br></p><p>You’ll work closely with clinical staff, billing teams, and insurance providers to untangle issues and make the process smoother for everyone involved. Every conversation is an opportunity to make a positive difference.</p><p><br></p><p><strong><u>What You’ll Do Every Day</u></strong></p><ul><li>Serve as the first point of contact for patients and providers by phone and email.</li><li>Answer questions related to scheduling, billing, and insurance verification with patience and clarity.</li><li>Research and resolve claims-related issues, including prior authorizations, coding questions, and payment discrepancies.</li><li>Keep detailed, accurate records in the patient management system to ensure smooth communication between departments.</li><li>Partner with clinical and administrative teams to provide timely updates and follow-up to patients.</li><li>Maintain confidentiality while handling sensitive medical and financial information.</li></ul>
<p>We are offering an exciting opportunity for an Accounts Receivable Supervisor in the healthcare industry, based in ODENTON, Maryland. This position sits on site and will manage a small team while being hands on with your work. The primary function of this role is to oversee and manage the billing and coding, pre-certification, and credentialing processes. This role is also responsible for maintaining accurate patient records, collecting outstanding payments, and following up with insurance companies. Small private-clinic healthcare experience required for consideration. </p><p><br></p><p>Responsibilities:</p><p><br></p><p>• Oversee and manage the process of obtaining authorization for pain management procedures from insurance companies.</p><p>• Supervise the billing and coding, pre-certification, and credentialing processes.</p><p>• Manage the collection of outstanding account payments and follow up with insurance companies and patient accounts.</p><p>• Maintain up-to-date knowledge of commonly-used concepts, practices, and procedures within the Medical Billing and Medical Insurance field.</p><p>• Ensure all tasks are completed simultaneously and independently with attention to detail and organization.</p><p>• Stay informed about various insurance companies and any relevant changes, keeping management updated.</p><p>• Work towards reducing aged A/R and analyze Explanation of Benefits (EOB’s) and Correspondence to identify zero pays and underpayments.</p><p>• Coordinate with healthcare insurance companies on outstanding medical claims and appeals.</p><p>• Maintain effective communication with the insurance verification team, billing department, and office support staff.</p><p>• Conduct collection actions and provide resolution for complex accounts, providing supporting documentation when necessary</p>
<p>We are looking for an experienced Medical Biller/Collections Specialist to join our team in Duarte, California. The Medical Biller/Collections Specialist will play a vital role in managing the revenue cycle for Skilled Nursing Facility services, ensuring claims are processed accurately and efficiently while adhering to Medicare, Medi-Cal, and other insurance guidelines. This is an excellent opportunity for a meticulous individual to contribute to a dynamic healthcare environment.</p><p><br></p><p>Responsibilities:</p><p>• Prepare and submit claims to insurance payers with accuracy and timeliness, focusing on Skilled Nursing Facility services.</p><p>• Investigate and resolve denied claims by identifying root causes and implementing corrective measures to reduce future denials.</p><p>• Draft and submit appeals for claim denials to secure appropriate reimbursements.</p><p>• Maintain comprehensive and accurate patient billing records in compliance with Medicare, Medi-Cal, and payer-specific requirements.</p><p>• Follow up with insurance companies and payers to resolve outstanding claims and ensure timely reimbursements.</p><p>• Stay up-to-date on federal, state, and local billing regulations to ensure strict adherence to compliance standards.</p><p>• Collaborate with administrative and clinical teams to streamline billing workflows and improve documentation processes.</p><p>• Generate detailed account reports that outline billing trends, claim statuses, and resolution timelines for management review.</p>
We are looking for an experienced Medical Billing/Claims/Collections specialist to join our team on a contract basis. This role is based in Northbrook, Illinois, and offers an excellent opportunity to contribute your expertise in medical billing and claims management within a dynamic healthcare setting. The ideal candidate will bring a strong understanding of medical collections, appeals, and denials processes, ensuring timely and accurate handling of claims.<br><br>Responsibilities:<br>• Manage medical billing operations, including hospital billing and claims processing, to ensure accuracy and compliance.<br>• Handle medical collections and follow up on outstanding claims with payers to secure payments.<br>• Investigate and resolve medical denials by reviewing documentation and initiating appeals as needed.<br>• Collaborate with healthcare providers and insurance companies to address claim-related inquiries and discrepancies.<br>• Utilize Epic software and other electronic medical record systems to maintain and update patient billing information.<br>• Ensure adherence to healthcare billing procedures, statutory requirements, and compliance standards.<br>• Perform research to support claim administration and resolve complex billing issues.<br>• Process payments and reconcile accounts to maintain accurate financial records.<br>• Escalate unresolved issues appropriately to ensure timely resolution.<br>• Provide training and support to staff on billing processes and system functionalities.
We are looking for an experienced Medical Billing Specialist to join our team in Rochester, New York. This Contract-to-Permanent position offers an exciting opportunity to contribute to a dynamic healthcare environment by managing billing operations and ensuring accurate claim processing. The ideal candidate will bring expertise in accounting software systems and a strong understanding of medical billing procedures.<br><br>Responsibilities:<br>• Process and submit claims to insurance providers efficiently and accurately.<br>• Manage accounts receivable and oversee collection procedures to ensure timely payments.<br>• Utilize accounting software systems and tools, including IBM AS/400, Medisoft, and Epic, to handle billing operations.<br>• Review and resolve claim appeals, ensuring compliance with healthcare regulations.<br>• Maintain and update patient billing records within electronic health record (EHR) systems.<br>• Collaborate with internal teams to address billing discrepancies and improve workflows.<br>• Monitor and analyze billing trends to identify areas for process optimization.<br>• Handle billing inquiries and provide exceptional customer service to patients and insurance representatives.<br>• Generate and present financial reports related to billing and collections.<br>• Stay informed about industry changes and updates to medical billing and coding practices.
<p>A Senior Software Business Analyst is needed to play a crucial role in connecting business requirements to technical solutions. This role involves engaging with stakeholders to gather and analyze requirements, transforming them into actionable functional specifications. Responsibilities include evaluating existing processes, offering solutions to drive business value, and ensuring project success under tight timelines. The position also includes mentoring junior analysts, leading cross-departmental projects, and fostering innovation. Strong analytical and communication skills, along with a solid understanding of software development life cycles, are essential to succeed in this fast-paced environment.</p><p>The ideal candidate will work closely with development and QA teams to monitor project milestones, provide updates to stakeholders, and address any project risks and challenges. A proactive approach to improving application usability and efficiency will be critical. Focusing on the specialty pharmacy sector, the organization provides end-to-end solutions including hub services, pharmacy network management, group purchasing (GPO) services, cutting-edge technology platforms, and more. With a strong presence as an industry advocate, the focus remains on delivering strategic channel management, advanced products, and tailored services to optimize patient outcomes and improve healthcare delivery.</p><p><br></p><p><strong>** Qualified candidates should have experience with pharmacy insurance, medical insurance, and claims processing **</strong></p><p><br></p><p><strong>Key Responsibilities:</strong></p><ul><li>Collect and translate business requirements into detailed functional specifications for new and existing systems.</li><li>Perform gap analyses between current system capabilities and business needs using tools like Confluence, flowcharts, and wireframes to document workflows.</li><li>Create use cases for review during functional testing phases by developers and QA teams.</li><li>Work with IT teams to evaluate project scope and affected systems, providing strategic insights.</li><li>Assess new methodologies for feasibility and implementation efficiency.</li><li>Gain in-depth knowledge of internal software platforms and their underlying functionalities.</li><li>Analyze and optimize existing processes to identify inefficiencies and propose re-engineering solutions.</li><li>Host regular meetings with development teams to resolve obstacles and track progress.</li><li>Provide project status reports to business stakeholders.</li><li>Identify potential risks and escalate issues as required.</li><li>Continuously explore opportunities to improve application functionality, making recommendations for enhancements.</li><li>Maintain compliance with HIPAA regulations and related amendments</li></ul>
We are looking for a detail-oriented Medical Claims Analyst to join our team in Raleigh, North Carolina. This long-term contract position is ideal for someone with extensive experience in medical claims processing and a strong ability to manage repetitive clerical tasks effectively. The role requires a collaborative team player who is dependable, punctual, and committed to delivering high-quality results.<br><br>Responsibilities:<br>• Process and reconcile medical claims efficiently, ensuring all records are accurate and up-to-date.<br>• Resubmit denied or rejected claims, following proper protocols to secure approvals.<br>• Post payments accurately into multiple systems, maintaining consistency and precision.<br>• Utilize payer portals to manage claims and track progress effectively.<br>• Perform clerical tasks such as data entry and filing with a focus on accuracy and attention to detail.<br>• Collaborate with a team of professionals to ensure smooth workflows and timely completion of tasks.<br>• Monitor claim statuses to identify and resolve discrepancies proactively.<br>• Maintain compliance with relevant policies and regulations in the healthcare industry.<br>• Provide support in behavioral health payment posting processes.<br>• Communicate effectively with team members and external parties regarding claim-related issues.
<p>We are looking for a dedicated Medical Billing Specialist to join our team! This position offers an opportunity to become a full cycle Revenue Specialist involved in all aspects of medical billing, coding, appeals, denials, and claims. Willing to train but prefer a certification in medical billing/coding and ideally 1-2 years' experience. Great organization with opportunities for growth beyond!</p><p><br></p><p>Responsibilities:</p><p>• Manage the full cycle of medical billing processes, including coding, claims submission, and payment reconciliation.</p><p>• Investigate and resolve claim rejections, denials, and appeals with insurance companies to secure proper reimbursement.</p><p>• Collaborate with the team to identify and address billing discrepancies or revenue losses.</p><p><br></p>
<p>Our healthcare client in Carlsbad is searching for a <strong>Billing Specialist</strong> to join their fast-paced and collaborative administrative team. This role is ideal for someone who enjoys problem-solving, has strong attention to detail, and thrives in an environment where accuracy and efficiency directly support patient care. The Billing Specialist will manage insurance claims, patient accounts, and billing inquiries. You’ll play a key part in ensuring that revenue cycles flow smoothly, and that both payors and patients are served with professionalism.</p><p><br></p><p><strong><u>Responsibilities</u></strong></p><ul><li>Process billing claims accurately and in a timely manner, ensuring compliance with insurance regulations.</li><li>Work with a wide range of payor groups, from commercial carriers to government programs.</li><li>Apply knowledge of CPT, ICD-10, and HCPCS coding when preparing claims.</li><li>Review and resolve claim rejections, denials, and outstanding balances.</li><li>Communicate with insurance companies, patients, and providers to clarify and resolve billing issues.</li><li>Maintain accurate patient billing records in the system.</li><li>Support month-end reconciliation and reporting related to billing and collections.</li><li>Collaborate with internal departments to ensure proper documentation is received for claims processing.</li></ul><p><br></p>
We are looking for a meticulous Medical Billing Specialist to join our team in Santa Barbara, California. This long-term contract position offers an excellent opportunity to contribute to the efficient management of radiology billing and insurance processes while ensuring compliance with industry standards. The ideal candidate will excel in communication and collaboration, supporting both patients and clinical staff in navigating complex billing and authorization procedures.<br><br>Responsibilities:<br>• Verify patient insurance eligibility and coverage for scheduled radiology exams, ensuring all checks are completed ahead of schedule.<br>• Initiate and secure prior authorizations or pre-certifications for radiology procedures, maintaining accuracy in coding and documentation.<br>• Follow up proactively with insurance providers to obtain approvals and communicate authorization status to patients and clinical teams.<br>• Address patient billing inquiries, assist with payment collections, and resolve discrepancies in claims or appeals.<br>• Process denied claims and write appeals for radiology procedures, ensuring timely follow-through on billing issues.<br>• Generate zero balance bills upon request and provide financial support to patients as needed.<br>• Maintain clear and precise communication with patients, physician offices, insurance companies, and internal staff.<br>• Document all interactions and updates accurately in electronic health and billing systems.<br>• Stay informed about changes in insurance regulations, payer policies, and coding guidelines relevant to radiology services.<br>• Ensure all processes adhere to compliance standards and organizational guidelines.
<p>We are offering an employment opportunity for a Medical Collections Specialist in Irvine, California. This role primarily involves managing and collecting outstanding accounts receivable from patients and third-party payers in the healthcare industry. The ideal candidate will exhibit a meticulous attention to detail and strong communication skills, ensuring accurate and timely collection of payments while adhering to billing protocols and maintaining patient confidentiality. </p><p><br></p><p>Responsibilities:</p><p><br></p><p>• Monitor and manage assigned accounts to identify outstanding balances</p><p>• Conduct daily follow-up on outstanding claims and patient accounts via phone calls, emails, and written correspondence</p><p>• Review and verify the accuracy of billing records and statements</p><p>• Process received payments, update account statuses, and maintain accurate records in the billing system</p><p>• Submit claims to insurance companies and follow up on denials, rejections, and partial payments</p><p>• Work with insurance companies to resolve discrepancies and ensure proper claim processing</p><p>• Respond to patient and insurance company inquiries regarding billing and account status</p><p>• Provide patients with explanations of benefits, payment options, and account resolutions</p><p>• Ensure all collections practices comply with federal and state regulations, including HIPAA</p><p>• Prepare and present regular reports on collection activities, account statuses, and outstanding balances</p><p>• Identify trends and propose solutions to improve collection processes and reduce outstanding accounts.</p>
We are looking for a detail-oriented Medical Billing Specialist to join our team on a contract basis in Devens, Massachusetts. In this role, you will play a vital part in ensuring accurate and timely billing processes while addressing appeals and denials. This position offers an opportunity to contribute to a dynamic healthcare environment.<br><br>Responsibilities:<br>• Handle medical billing tasks, including claims processing and submissions.<br>• Manage appeals and denials to ensure proper resolution and reimbursement.<br>• Conduct thorough reviews of medical claims for accuracy and compliance.<br>• Collaborate with insurance providers and patients to address billing inquiries.<br>• Maintain up-to-date knowledge of medical coding standards and billing regulations.<br>• Utilize Epaces and other systems to track and manage claims effectively.<br>• Perform follow-ups on outstanding collections and payments.<br>• Assist with special projects related to billing operations as needed.<br>• Ensure confidentiality and security of patient billing information.
We are looking for a skilled Claims Examiner specializing in lost time claims to join our team on a contract basis in Jersey City, New Jersey. In this role, you will oversee the full lifecycle of workers' compensation claims, ensuring compliance with regulations while maintaining strong relationships with all involved parties. This position requires someone with excellent attention to detail, capable of managing complex claims processes and delivering high-quality service.<br><br>Responsibilities:<br>• Manage workers' compensation lost time claims from initial setup to closure, maintaining excellent customer relationships throughout the process.<br>• Conduct thorough investigations by reviewing policy details, collecting statements, and gathering facts from claimants, insured parties, and medical providers.<br>• Evaluate gathered information to determine claim compensability and communicate decisions regarding claim approvals or denials to all relevant parties.<br>• Administer statutory medical and indemnity benefits in a timely manner, ensuring compliance with applicable regulations.<br>• Set and adjust claim reserves for medical, indemnity, and related expenses, recommending changes to the Team Leader as necessary.<br>• Partner with attorneys to oversee litigation processes, including hearings, and manage legal documentation.<br>• Direct and coordinate efforts with vendors, nurse case managers, and rehabilitation managers to support medical management and return-to-work initiatives.<br>• Prepare and submit reports on claim settlements, denials, evaluations, and potential exposures to the Team Leader.<br>• Ensure compliance with state regulations by filing workers' compensation forms and electronic data accurately and on time.<br>• Identify subrogation opportunities and work to recover claim-related costs effectively.
We are looking for an Insurance Follow-Up Specialist to join our team in Tampa, Florida. In this Contract to permanent position, you will play a vital role in ensuring timely insurance claim processing and maintaining strong relationships with partners. If you have a knack for organization, persistence, and excellent communication, this opportunity is designed for you.<br><br>Responsibilities:<br>• Pursue prompt collection of signatures and necessary documents from funeral home partners to expedite claim processing.<br>• Investigate delays in insurance claims and provide solutions with a proactive and detail-oriented approach.<br>• Build and nurture strong partnerships with insurance representatives and funeral home stakeholders.<br>• Maintain comprehensive and accurate records to ensure all cases are tracked and managed effectively.<br>• Collaborate with the Concierge team to provide additional follow-up support as needed.
Job Summary:<br>Overall responsibility for contacting all assigned patient and insurance/third party payer accounts with a debit balance to ensure receipt and processing of claim within 45 days from the date of service. Perform appeals for underpaid claims or claim denials as assigned by the Billing Manager. Procure payment or establish payment arrangements with patients and/or guarantors in accordance with business office policies and procedures. <br>Principal Duties and Responsibilities:<br>• Works a detailed daily work queue for assigned accounts over 31 days old.<br>• Works detailed aging report as assigned for accounts over 31 days old.<br>• Audits assigned accounts for proper insurance filing. Compares posted payments to EOBs to confirm proper patient balances prior to patient collection attempts.<br>• Keeps up-to-date on vital contract information concerning assigned payers to establish proper and timely payment of claims.<br>• Determines average claim entry, processes timeframes for assigned payers, and determines the status of unpaid claims beginning from the 45th workday from the date of service.<br>• Responsible for using Replica to extract needed EOB’s or zero pay EOB’s when needed.<br> <br>• Utilizes approved appeal form letters to submit appeals in accordance with billing office policies and procedures.<br>• Forwards medical or coding denials to the QA Department for nurse review and appeal.<br>• Demands claims for secondary insurance filing and copies explanation of benefits in accordance with business office policies and procedures.<br>• Procures applicable payment from patients, or establishes payment arrangements not to exceed 120 days from the date of service.<br>• Skip traces accounts according to established practices.<br>• Reviews payment arrangement accounts that have not had regular payments in over a month.<br>• Initiates collection letters and/or statements to patients in accordance with business office policies and procedures.<br>• Responsible for neatness of work area and security of patient information in accordance with the Privacy Act of 1974 and the Health Information and Portability Act (HIPAA).<br>• Works with Manager and Compliance Committee to ensure Compliance Program is followed.<br>• Performs other duties as assigned or requested.<br>Knowledge, Skills, and Abilities:<br>• Has a working knowledge of the Fair Debt Collection Act and state and federal laws applying to collection activities.<br>• Excellent verbal and written communication skills, interpersonal skills, analytical skills, organizational skills, math skills, accurate typing and data entry skills.<br>• Ability to deal professionally, courteously, and efficiently with the public.<br>• Treat all patients, referring physicians, referring physicians’ staff, and co-workers with dignity and respect. Be polite and courteous at all times. <br>• Knowledge of all confidentiality requirements regarding patients and strict maintenance of proper confidentiality on all such information.<br>• Knowledge of medical terminology, CPT and ICD-10 coding, office ethics, and spelling.<br>• Must be computer literate.<br>• Must possess knowledge and understanding of managed care and insurance practices.<br>Education and Experience:<br>• High School graduate, technical school, or related training preferred.<br>• Accounts Receivable and collection experience.<br>• One-year work experience in a medical office or equivalent.<br><br><br> <br><br><br><br>_________________________ ____
<ul><li><strong>Position: Claims Examiner - Lost Time (Contract Role)</strong></li><li><strong>Location: 555 Long Wharf Drive New Haven CT USA 06511-5941</strong></li><li><strong>Type: 100% Onsite</strong></li><li><strong>Hourly Pay Range: $30-33/per hour</strong></li><li><strong>Interview Process: Virtual interview 1-2 round of 30 minute interview</strong></li></ul><p> </p><p><strong>Job Description: </strong></p><p>Job Schedule-100% ONSITE</p><p>Job hours-8:30am-5:00pm EST</p><p> </p><p>3 years of Workers Compensation Lost Time Claim Examiner or Commensurate Experience </p><p> </p><p>Duties and Responsibilities:</p><p>- Handles all aspects of workers compensation lost time claims from set-up to case closure ensuring strong customer relations are maintained throughout the process.</p><p>- Reviews claim and policy information to provide background for investigation.</p><p>- Conducts 3-part ongoing investigations obtaining facts and taking statements as necessary with insured claimant and medical providers.</p><p>- Evaluates the facts gathered through the investigation to determine compensability of the claim.</p><p>- Informs insureds claimants and attorneys of claim denials when applicable.</p><p>- Prepares reports on investigation settlements denials of claims and evaluations of involved parties etc.</p><p>- Timely administration of statutory medical and indemnity benefits throughout the life of the claim.</p><p>- Sets reserves within authority limits for medical indemnity and expenses and recommends reserve changes to Team</p><p>Leader throughout the life of the claim.</p><p>- Reviews the claim status at regular intervals and makes recommendations to Team Leader to discuss problems and remedial actions to resolve them.</p><p>- Prepares and submits to Team Leader unusual or possible undesirable exposures when encountered.</p><p>- Works with attorneys to manage hearings and litigation</p><p>- Controls and directs vendors nurse case managers telephonic cases managers and rehabilitation managers on medical management and return to work initiatives.</p><p>- Complies with customer service requests including Special Claims Handling procedures file status notes and claim reviews.</p><p>- Files workers compensation forms and electronic data with states to ensure compliance with statutory regulations.</p><p>- Refers appropriate claims to subrogation and secures necessary information to ensure that recovery opportunities are maximized.</p><p>- Works with in-house Technical Assistants Special Investigators Nurse</p><p>Consultants Telephonic Case Managers as well as Team Supervisors to exceed customer's expectations for exceptional claims handling service.</p>
We are looking for a detail-oriented Medical Payment Poster Specialist to join our team in Sacramento, California. This contract-to-permanent position offers an excellent opportunity for individuals skilled in medical billing, coding, and payment posting. The role requires working on-site during the contract assignment, with potential for long-term placement.<br><br>Responsibilities:<br>• Accurately post insurance payments by line item to the patient account system, ensuring all entries are precise and compliant.<br>• Verify payment amounts against contracts and organizational policies to ensure correctness.<br>• Process patient payments efficiently and update records within the designated system.<br>• Record denials, zero payments, and flag accounts for follow-up by the Medical Collections team.<br>• Apply takebacks and recoupments in accordance with established policies.<br>• Identify and communicate trends in payment discrepancies, denials, or short payments to leadership for resolution.<br>• Balance daily payment entries against settlement reports to maintain accurate financial records.<br>• Route payer correspondence to the appropriate team members for timely follow-up.<br>• Utilize knowledge of contracts and policies to ensure proper application during payment posting.
