Medical Claims Billing Specialist

*This position is a hybrid full-time role that requires in office on Tuesdays and Thursdays at 1200 Binz St Suite 1490 Houston TX 77004. Mon, Wed, and Fri are typically work from home but subject to change for internal meetings, trainings, and conferences.*

Under the direction of the Sr. Manager of Revenue Cycle Management, the Medical Claims Billing Specialist - Case Management (AR Manager) is responsible for complete, accurate and timely processing of all designated claims, reviewing and responding to daily correspondence from physician practices in a timely manner, answering incoming SalesForce cases and providing information as requested or properly authorized. The Medical Claims Specialist will take steps necessary to resolve all claim issues or questions that escalate to the RCM team. 

Primary Job Duties:

• Denial management - investigating denial sources, resolving and appealing denials which may include contacting payer representatives

• Makes independent decisions regarding claim adjustments, resubmission, appeals, and other claim resolution techniques

• Collaborate with internal teams (Performance, Operations, Sales) as well as care center staff when appropriate

• Works closely with our Revenue Optimization team, to support efforts to ensure reimbursement is in line with payer contract agreements. 

• Work directly with practice consultants or physicians to ensure optimal revenue cycle functionality

• Drive toward achievement of department’s daily and monthly Key Performance Indicators (KPIs), requiring a team focused approach to attainment of these goals

• Other duties as assigned