Claims Specialist
JOB TITLE: Claims Specialist
EMPLOYER: Limitless Male Medical
DEPARTMENT: Revenue Cycle
REPORTS TO: Revenue Cycle Manager
EFFECTIVE DATE: 7 /1/24
WHY LIMITLESS MALE MEDICAL CLINIC:
Limitless Male is a fast-growing, unique, and team-oriented company that loves to take care of our employees AND our patients. If you are looking to be surrounded by excellence, to be inspired by your peers, to help make a difference, and laughing the whole time… then we need to talk! We also pride ourselves in offering many benefits including health insurance, Limitless Male branded clothing, discounts, a great culture, and more! This is a place you can come in and help men of all walks of life achieve their goals and simply be a better them.
ABOUT THE ORGANIZATION:
What is Limitless Male? We are a men’s health clinic where every day, we open the doors to invite men of all ages to change their lives and get back in the game by becoming better husbands, fathers, and co-workers. We do it through various avenues of testosterone replacement, peptides, wave therapies, and many other ancillary products to help men feel their best!
SUMMARY:
The Claims Specialist is responsible for successfully submitting all claims to payers in accordance with payer guidelines and regulations. The Claims Specialist will ensure accuracy and acceptance by the payer of each claim submitted by LMMC and its affiliates both electronically and on paper.
Duties and Responsibilities
- Electronic and paper submission of claims to all payers ensuring compliance and edit resolution in both the patient account system and the clearing house
- Identifies and researches complex claim issues bringing opportunities for improvement to the Revenue Cycle Manager
- Auditing accounts for necessary corrections
- Updating coverage information on patient accounts as needed
- Meets or exceeds all department standards: productivity; quality; and attendance
- Demonstrate solid judgment and discretion working with confidential information
- Comply with all department and company guidelines including all applicable laws and
- Work with teams inside and outside the department, and external customers as needed to ensure best in class revenue cycle operation.
- Maintain strong knowledge of payer, state, and federal regulations as it relates to the processing of claims
Other Job Duties
- As assigned by the revenue cycle manager
- 2-3 years’ experience in professional fee revenue cycle within in any area of the back office required
- Solid working knowledge of claim processing from all perspectives (submissions, processing,
- dependencies)
- Proficient in medical software and technology
- Proficient with Microsoft Office applications
- Ability to multitask, prioritize workload, and meet deadlines
- Excellent verbal and written communication skills
- Detail oriented
- Ability to work in a fast-paced environment
- Strong customer service skills
- Ability to answer patient and insurance company questions
- Ability to work independently and in a team environment
- Strong problem-solving skills
- Results oriented