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Medical Billing Specialist

This position is responsible for dealing with accounts that have been pended, rejected or partially paid by insurance companies and following up accordingly in order to secure prompt payment for Medserv clients. Tasks include investigation of claims’ history, interpretation of recent action taken by other colleagues, decision making, identifying trends and patterns in shortfalls and/or billing errors and daily communication with 3rd parties.

Duties & Responsibilities:

  • Reviewing medical documentation such a operation records, nursing notes and laboratory tests which are required to progress a claim or support a due balance
  • Pulling and analysing reports related to pended, rejected and partially paid claims, interpreting billing rules and pursuing payments accordingly
  • Become familiar with the various Insurers billing rules in order to make sound decisions on when to accept a payment for procedures billed
  • Requesting additional documentation such as medical notes and outlier letters from clients/secretaries/hospitals
  • Responding to daily queries via email and phone from external and internal personal, assisting with the preparation of reports to clients, superiors and for other internal purposes.
  • Data entry & making requests for more medical information from clients or hospitals where necessary
  • Daily interaction with colleagues in order to optimise the efficient submission and payment of claims
  • Daily interaction with external entities such as Insurers, Patients and Hospitals, to include calling and emailing insurance companies to discuss claim status and dispute shortfalls
  • Attend weekly team meetings to discuss issues and updates relevant to the team
  • Keeping a strong focus on attention to detail, quality, completeness and accuracy
  • Attend in house training as scheduled where the opportunity arises to learn new skills
  • Training in new members of staff
  • Ad hoc duties as they arise

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