Medical Claims Specialist

Welcome to Orthopaedic Associates of Duluth - where health meets happiness! We're not just about treating patients; we're about creating a healthy work environment that's as vibrant as our medical expertise. More importantly, we are locally owned and care about our employees and community. We are looking for a detail-oriented full-time Medical Claims Specialist to support our growing orthopedic practice. We are looking for individuals who enjoy working with a variety of Orthopedic Sub-Specialties to include General Ortho, Foot & Ankle, Hand, Total Joints, and Sports Medicine. We strive to provide optimal access to all levels of orthopedic care and provide consistently high service giving patients the best experience possible. In addition to our team environment and quality patient care, we offer a comprehensive compensation and benefits package.

Job Summary:

The Medical Claims Specialist will compute, bill, post, and collect patient accounts and perform other duties as required.

Supervisory Responsibilities:

None Duties/Responsibilities:

Act as liaison between providers, patients, and payers to ensure accurate charges and records. Verify charge accuracy for diagnosis, treatment, and services, and maintain accounts using automated billing systems for insurance reimbursement. Interpret and process Explanation of Benefits (EOBs), collect medical data, and submit claims to various payers, including Medicare and third-party insurers. Communicate with payers until accounts are paid or referred for further collection. Resolve claim rejections and review EDI rejections in the Clearinghouse dashboard. Assist patients via phone, process payments, and collect surgical pre-payments. Coverage for Patient Registration when necessary. Other duties as assigned.

Work Comp Responsibilities:

Contact carriers for claim status, collect payments, and obtain billing information. Appeal denied claims, track claim statuses, and collaborate with adjustors. Handle uncollectible accounts with discretion.

Patient Accounts Responsibilities:

Research accounts, assist with payment plans, and process overpayment refunds. Report old debts to collection agencies and collaborate with patients on payment plans. Apply private pay discounts and generate/distribute statements weekly.

Required Skills/Abilities:

Knowledge of medical billing terminology, office practices, and basic math. Professional, tactful, and courteous communication with patients, coworkers, and third parties. Quick learner with the ability to navigate multiple platforms and systems. Ability to gather and evaluate sensitive information while maintaining confidentiality. Skilled in interpreting and applying regulations, policies, and procedures. Self-motivated, detail-oriented, and capable of producing accurate written communication. Strong organizational skills, with the ability to prioritize tasks and meet deadlines. Knowledge of medical billing codes (CPT, ICD-10), fiscal recordkeeping, and collection laws. Ability to educate patients on financial responsibility and appeal to insurers for payments.

Education and Experience:

• Associate's Degree in related field OR a Certificate in Medical Billing (Preferred)
• One year of general office experience involving public contact in a medical office; or
• A combination of training, education, and experience that is equivalent to the employment standard listed above and that provides the required knowledge and abilities
• Insurance verification: 1 year (Preferred)
• Experience with

Microsoft Suite:

1-3 years (Preferred)

• Experience utilizing an Electronic Medical Record system (EMR)

Physical Requirements:

• Prolonged periods of sitting at a desk and working on a computer
• Must be able to lift up to 15 pounds at times
• Efficiency with an occasionally noisy environment
• Dress code: Scrubs (Navy Blue and/or Black) $150 annual uniform reimbursement available

Job Type:

Full-time Hourly Rate (Non-Exempt): starting at $18.00 per hour

Schedule:

• 8 hour shift (Monday - Friday, 8:00am - 4:30pm)

Work Location:

In person

Job Type:

Full-time Pay:

$18.00 - $21.00 per hour

Benefits:

401(k) 401(k) matching Dental insurance Flexible spending account Health insurance Life insurance Paid time off

Work Location:

In person