Connext Global Solutions - Medical Claims Specialist

Job Description

Responsibilities

Organize data and submit claims for all assigned contracts.

Verify hours/ review group notes.

Complete daily/monthly audits ensuring all billable days have been accounted for and submitted.

Ensure all policies are billed for with monthly SharePoint VOB checks.

Communicate actions that need to be taken to submit claims.

Communicates department needs to assigned Charge Specialist or Director.

Maintains up to date knowledge of insurance payer requirements.

Attendance report missing/short hours are reported to Charge Specialists biweekly basis and audited before submission to the facility.

Resubmission of all claims that need corrections.

Participate in monthly trainings.

Participate in completion of special projects.

Qualifications and Requirements

Understanding of various insurance payer requirements and policies to ensure compliance.

Proficiency in maintaining organized records of claims, communications, and documentation.

Proficiency in using Microsoft Office Suite for document management and collaboration.

Ability to use Collaborate MD for submitting, tracking, and managing insurance claims efficiently.

Ability to enter and review data meticulously to ensure all information is correct and complete.

Clear and coherent in both written and verbal communication skills to articulate actions and issues related to claims to internal stakeholders and external contacts.

Strong time management skills to prioritize tasks, manage deadlines, and handle multiple claims simultaneously.

Ability to address and resolve conflicts or disputes related to claims and reimbursements.

Adherence to ethical standards and company policies in handling claims and personal data.