Managed Care Medical Billing Specialist

A leading hospital in Los Angeles is seeking a detail-oriented Managed Care Medical Billing Specialist to join its revenue cycle team. This role is responsible for ensuring accurate and timely claim submission, follow-up, and resolution of managed care billing issues. The ideal Managed Care Medical Billing Specialist will have strong knowledge of medical billing processes, payer requirements, and accounts receivable follow-up within a hospital environment.

Key Responsibilities:

Demonstrate the ability to determine the accuracy of pertinent medical, coding, eligibility, authorization, demographic, and financial information, and make any required corrections. Determine payer documentation requirements for payment and ensure all necessary supporting documentation is available for claim submission. Transmit and submit clean claims to payers within three working days of receipt, while maintaining a productivity standard of 200 claims per day.

Update the computer system to reflect claim submission and transmission activity. Review payer correspondence and provide corrections and/or additional documentation within three working days. Review payment data for suspensions, underpayments, and denials, and submit appropriate responses, including corrected insurance forms and rebills as needed. Review bi-monthly accounts receivable reports to identify claims that have been submitted but remain unresolved or unacknowledged, as well as claims that have not yet been submitted, and take appropriate action to ensure timely resolutionPreepare adjustments needed to ensure account balances reflect payable amounts and forward them to management for review and authorization.