Claim Specialist/Coder

Job Description

Overview

We are seeking a detail-oriented and highly skilled Claim Specialist/Coder to join our busy Ophthalmology Surgery Center. The ideal candidate will possess a comprehensive understanding of medical coding, billing, and claims processing, ensuring accurate and efficient submission of insurance claims and processing claim denials and appeals. The Claim Specialist/Coder will play a vital role in optimizing revenue cycle operations while maintaining compliance with industry standards and regulations. Hours are Monday through Friday 8:00am to 4:30pm.

Responsibilities

Resolve claim denials or rejections and implementing corrective actions with the proper appeals.

Collaborate with medical biller to ensure proper documentation supports coding decisions and accuracy.

Occasional billing of charges.

Stay current with updates to coding guidelines, payer policies, and regulatory changes affecting medical billing practices.

Maintain detailed records of claim submissions, adjustments, and follow-up with medical records requests.

Must be able to multitask and work in a team environment.

Qualifications

Three years minimum experience

Proven experience in medical coding, billing, or claims processing within a healthcare setting.

Excellent attention to detail with the ability to interpret clinical information accurately.

Effective communication skills for collaborating with healthcare providers, insurance companies, and internal teams.

Extensive knowledge of insurance-related policies

Knowledge of Medicare rules, local and national coverage determination.

Ophthalmology knowledge a bonus

Ambulatory Surgery Center claim knowledge a bonus

Benefits:

401(k)

401(k) matching

Dental insurance

Health insurance

Health savings account

Life insurance

Paid time off

Full-time