Medicaid / Medicare Billing Specialist

Insurance Claims Resolution Specialist

Responsible for the timely and accurate resolution of insurance claims, primarily for Medicare, Medicaid, and HMO plans. This role involves follow-up on claims from billing through final resolution, identifying and correcting errors, and ensuring prompt payment of outstanding accounts.

Key Responsibilities

• Claim Follow-up

Monitor the progress of insurance claims from submission to payment.

Review daily electronic billing reports, paper claim submissions, and third-party confirmation reports for errors.

Process Medicare RTP claims and denial reports on a daily basis.

Research outstanding accounts and take appropriate action to secure prompt payment.

Research partial payments to determine if the appropriate contractual allowance was calculated.

Research rejected or denied services and determine corrective action.

Complete productivity reports and submit to supervisors within the established timeframe.

Support the department's customer service and performance improvement goals.

Maintain strict confidentiality of patient information.

Required Qualifications