Revenue Cycle Specialist - Claim Processing

Job Description

Join Max Surgical Specialty Management, an innovative leader in the healthcare industry, as we embark on an exhilarating journey of growth and expansion!

We are seeking a motivated and dynamic individual to join our Revenue Cycle Management Team as a Revenue Cycle Specialist – Claim Processing.

What You'll Do:

The Revenue Cycle Specialist – Claim Processing is responsible for ensuring the accuracy and efficiency of insurance claim submissions, optimizing revenue cycles while maintaining exceptional service standards. By leveraging expertise in billing and accounts receivable management, the position supports timely payment collection, resolves claim discrepancies, and fosters transparent communication with stakeholders, contributing to the financial success and operational excellence of the organization.

The successful candidate will be able to:

Review and monitor all claims queues for assigned offices

Examine patients’ chart in the queue, verifying demographic, insurance, and subscriber details for data accuracy

Research all information needed to complete billing processing

Post any corrections to claims to ensure integrity of account information

Review claim submission reports to ensure claims were submitted and accepted by clearing house

Work clearing house rejections and resubmit claims with corrections

Run daily system charge error report and make necessary corrections to submit a clean claim

Maintains a good working knowledge of the specific billing requirements for all payers

Assign appropriate CDT, CPT codes and appropriate ICD- 10-CM diagnosis codes selecting the codes that accurately describe the condition for which the service or procedure was performed

Review claim editing reports for consistent errors and follow up with the management for improvement in quality and performance

Review patient demographics and Insurance make any corrections necessary before claim submission

Confirm both Dental and Medical insurances have been verified, and the system reflects any chances necessary

Validate claims address and electronic payer ID are correct in the system, check insurance cards to ensure the correct plan is selected

Work with front office staff regarding any information missing in patients’ accounts that is needed for claims submission (e.g., insurance details, subscriber info, biopsy reports, etc.)

Gather all necessary documents and images needed to create required attachments for claim submission

Configure scans to panoramic x-rays as needed for claim submission

Respond to insurance-related phone calls and return patient voicemails

Compile daily reporting excel sheets to send to the manager weekly

Run and save Claims Status, Transmission Log, and Claims Submission reports daily

Perform any and all other duties as assignedWhat You’ll Bring:

High School Diploma required, Medical Billing and/or Coding Certification highly preferred

3+ years of hands-on experience in healthcare revenue cycle management, with a proven track record of optimizing processes

Proficient in all Microsoft Office applications as well as medical office software

Proven experience in healthcare billing

Sound knowledge of health insurance providers

Strong interpersonal and organizational skills

Excellent customer service skills

The ability to work in a fast-paced environmentPerks of the Job:

Highly competitive salaries & annual performance and compensation reviews

Competitive health insurance and benefits, including medical, dental, vision, disability, and more

401k retirement savings plan that includes employer match

Generous Paid Time Off, sick leave, and paid holidays

Advance your career growth with opportunities in the most extensive growing oral surgery practice in the NortheastAbout MAX Surgical Specialty Management:

Established in September 2022 as the Northeast region’s first oral and maxillofacial surgery-only specialty platform, MAX Surgical Specialty Management is a surgeon-led management services organization developed with clinical and surgeon autonomy at its core. Today, MAX supports surgeons across New Jersey, New York, Pennsylvania, Vermont and Connecticut, enabling practices to channel resources, skills and knowledge within the oral surgery specialty, leading industry advancements and delivering the highest standard of patient care. Surgeons have access to a curated network that allows them to collaborate with and work alongside a diverse pool of highly skilled peers who are leaders in their specialty. MAX safeguards surgeons’ independence while offering robust support systems, access to advanced technology and opportunities for financial growth.

Integrity-driven. Patient-focused. Experience the difference at

MAX Surgical Specialty Management is an equal opportunity employer committed to providing fair employment opportunities regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, genetic information, marital status, veteran status, or any other legally protected characteristic. We welcome diversity and encourage applicants from all backgrounds. Our inclusive environment values and empowers every employee to contribute to our mission.

Powered by JazzHR

roFyPoygtn

Full-time