Claims Specialist Advanced Pain Management and Spine Specialists - 3.5 Fort Myers, FL Job Details Full-time $21 - $23 an hour 21 hours ago Benefits Health savings account Health insurance Dental insurance 401(k) Paid time off Vision insurance 401(k) matching Qualifications Customer communication Microsoft Outlook Spreadsheets Pain management experience Practice management software HIPAA Patient management software Medical coding experience in physician offices High school diploma or GED Data interpretation Medical Billing & Coding Associate's degree Medical terminology

Full Job Description Job Title:

Claims Specialist Department Revenue Cycle Management / Billing Department Job Overview The Claims Specialist is responsible for ensuring accurate and timely submission, follow-up, and resolution of medical claims for a pain management practice. This role works closely with providers, insurance carriers, patients, and billing staff to maximize reimbursement, reduce claim denials, and maintain compliance with federal, state, and payer regulations. The Claims Specialist with a strong understanding of pain management procedures, coding, and payer requirements a plus. Duties Review and submit professional medical claims accurately and timely to commercial insurance, Medicare, Medicaid, workers' compensation, and managed care payers. Monitor claim status and follow up on unpaid, denied, rejected, or underpaid claims. Investigate claim discrepancies and resolve billing issues to ensure appropriate reimbursement. Analyze Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERAs). Submit claim corrections, appeals, reconsiderations, and supporting medical documentation as required. Verify coding and billing accuracy related to pain management services, including injections, nerve blocks, radiofrequency ablation procedures, spinal cord stimulator services, and office visits. Identify denial trends and recommend process improvements to reduce future denials. Maintain detailed documentation of collection efforts and payer communications. Collaborate with insurance verification, coding, authorization, and clinical staff to resolve claim issues. Ensure compliance with HIPAA, payer guidelines, and healthcare billing regulations. Assist patients with insurance-related inquiries regarding claim processing and financial responsibility. Meet established productivity and collection goals. Education High School Diploma or GED required. Associate degree in Healthcare Administration, Medical Billing, or related field preferred. Requirements Knowledge of CPT, ICD-10-CM, HCPCS, and medical terminology. Understanding of pain management procedures and specialty billing requirements. Strong knowledge of insurance claims processing and denial management. Proficiency with Electronic Health Records (EHR) and practice management systems. Strong analytical and problem-solving skills. Excellent written and verbal communication skills. Ability to prioritize tasks and manage multiple accounts effectively. Proficiency in Microsoft Office applications, particularly Excel and Outlook. Ability to work independently and collaboratively within a team environment. Performance Expectations Maintain timely claim submission and follow-up activities. Achieve department productivity and collection goals. Minimize claim denials through proactive account management. Maintain accuracy and compliance with all regulatory and payer requirements. Demonstrate professionalism and excellent customer service in all interactions.

Equal Opportunity Employer:

The practice is committed to creating an inclusive workplace and providing equal employment opportunities to all employees and applicants.

Pay:

$21.00 - $23.00 per hour

Benefits:

401(k) 401(k) matching Dental insurance Health insurance Health savings account Paid time off Vision insurance

Work Location:

In person