Medical Claims Specialist

Overview

Florida Pediatric Associates is seeking an experienced Medical Claims Specialist to join the team.
Hybrid Work
:
Employee will be able to work 4 days from home and 1 from the office.

• 90% Employer Paid Employee Medical
• Dental
• Vision
• 100% Employer Paid STD & LTD
• Supplemental Insurance Options
• 7 Paid Holidays
• 401k Plan and Amazing Work Environment

• High School diploma or equivalent.
• Certification in medical coding (CPC) preferred.
• Working knowledge of Medicare and Florida Medicaid coding rules and regulations including but not limited to as National Correct Coding Initiative edits and payer guidelines.
• Working knowledge of the current International Classification of Diseases (ICD), Current Procedural Technology (CPT) and Healthcare Common Procedure Coding System (HCPCS) coding and terminology.

• Two or more years of medical claims collection/accounts receivable
• Management experience including patient (self-pay), commercial and government payer classes.
• ICD, CPT and HCPCS coding experience.

• Strictly adhere to Department Policies, Procedures and Protocols, especially those that apply to medical claims collection duties and processes.
• Strictly adhere to the Company Compliance Program and immediately report suspected acts of non-compliance to the Department Director or designee.
• Strictly adhere to the Company Privacy and Security Standards and immediately report suspected breaches to the Department Director or designee.
• Strictly adhere to the Department Quality Improvement and Assurance Program and immediately report deviations from quality metrics to Department Director or designee.
• Demonstrate proficiency in Navicure system processes applicable to managing claim rejections and denials.
• Review and analyze third party payer accounts receivable and execute necessary collection actions and follow-up as prescribed by Department Policies, Procedures and Protocols.
• File claim appeals for denied and rejected claims per payer guidelines, including but not limited to payer-imposed deadlines.
• Verify patient insurance eligibility.
• Verify patient account balances.
• Verify insurance company refund requests.
• Research and respond to payer questions and requests for information as prescribed by Department Policies, Procedures and Protocols.
• Research and respond to patient questions pertaining to outstanding balances.
• Documents all collection efforts in the “coded notes” field of the practice management system.
• Ensure the timely and accurate collections of accounts receivable for assigned payers.
• Maintain payer aged accounts receivable greater than 120 days within the benchmark defined by Department Policies and Procedures.
• Promptly report coding-related issues to the Department Director or designee.
• Promptly report unsuccessful collection efforts and collection problems to Department Director or designee.
• Promptly notify the Department Director or designee for trends identified pertaining to denials and when the volume of denials for a particular CPT code appears excessive.
• Monitor and report any payer related claims issues to the Department Director or designee.
• Promptly report matters that delay or disrupt workflow to the Department Director or designee.
• Perform other duties as assigned.

• Serve as brand representative for FPA by embracing the Company culture and mission statement, core values and standards of conduct.
• Strictly adhere to all Standards, Compliance Standards, Privacy and Security Standards, Workplace Standards and Workforce Standards.
• Strictly adhere to Department policies and procedures.
• Participate in quality assurance and quality improvement processes.
• Participate in the corporate compliance program.
• Promptly report suspected acts of non-compliance with Company Standards and Policies.
• Participate in job-related continuing education programs.
• Perform other duties as assigned by your supervisor or designee.

FPA provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression. In addition to federal law requirements, FPA complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.