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Medical Claims and Denial Specialist


Call Center and Customer Service

Advert ID



Stuart,Okeechobee,Vero Beach,Fort Pierce

Job Type




Salary Range

12.0 - 12.0 HOURLY

No. of Openings


Branch Information

Fort Pierce, FL - (USA) 900 Virginia Avenue Suite 16 FL Fort Pierce , FL - 34982 Phone : 772-464-7771



Job Description

Include the following as well as other duties and responsibilities, which may be assigned:
1. Reviews claims for accuracy prior to claim submission
2. Ensures the required supporting documentation is on file prior to claim submission as determined by the company and/or the insurance plan/government payer
3. Identifies and resolves claim rejections
4. Identifies and resolves claim denials
5. Maintains a working knowledge of the payer’s appeals process
6. Mark accounts for no bill when irregular conditions cannot be resolved before billing/timely filing date.
7. Identification and recommendation for resolution for payer trends preventing or delaying payment working with management to resolve.
8. Submits accurate electronic and CMS 1500 paper claims in accordance with company and payer guidelines.
9. Adherence to established productivity and quality thresholds
10. Provides recommendations for continued improvement to the billing process.
11. Adhere to departmental and company policies and procedures

Medical Claim and Denial Specialist is responsible for generating revenue by the timely processing and submission of clean medical claims to all payers including insurance companies, federally subsidized government plans such as Medicare Parts B and C, Medicaid, Medicaid Managed, as well as patient billing. The Medical Claim and Denial Specialist is also responsible for reviewing reports/work queues to identify and to correct the root cause for claim rejections, and denials which might prevent or delay payment of a particular claim or group of claims

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily and must possess the ability to: interact professionally and ethically with third parties including insurance plans, patients, and caregivers as well as with co-workers and management; handle multiple tasks simultaneously; Provide clear, concise oral and written directives/communications; Quickly assess situations and respond appropriately; Handle special requests in a sensitive, professional manner. Demonstrates the ability to problem solve, prioritize and organize. Ability to follow directives with accuracy and precision; Assist with and participate in fostering a team environment.

The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. High School diploma and 1-3 years of medical billing experience
2. Detail oriented individual with medical billing and collections experience.
3. Experience billing commercial insurance, Medicare parts B and C as well as Medicaid claims.
4. Durable Medical Equipment experience preferred.
5. Experience & knowledge of Brightree billing software preferred.
6. Proficiency with Microsoft Office including Excel a plus.