Medical Claims Specialist

We are seeking a Medical Claims Specialist with at least 3 years of experience in Physician Revenue Cycle Management. You will handle the submission, tracking, and appeal of professional (CMS-1500) medical claims to ensure accurate and timely reimbursement for our providers.

*Starting pay will be Dependent Upon Experience*

Key Responsibilities:

• Claim Submission: Review and submit clean professional claims (CMS-1500) to commercial and government payers.

• Denial & AR Resolution: Track outstanding claims, research rejections, and file effective appeals to overturn denials.

• Payer Follow-Up: Monitor aging AR reports and contact insurance companies to resolve unpaid claims.

• Coding Review: Verify correct application of CPT, ICD-10, HCPCS codes, and modifiers.

• EOB Auditing: Review EOBs/ERAs to verify payments align with contracted fee schedules.

Requirements:

• Experience: Minimum 3+ years in Physician Billing / RCM (Professional billing experience is required; UB-04/Facility-only experience will not qualify).

• Tech Skills: Hands-on experience with medical billing software/PM systems and clearinghouses.

• Knowledge: Strong understanding of NCCI edits, insurance guidelines, and the appeals process.

• Certification (Preferred): CPC certification is a plus.