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Medical Claims and Billing Specialist

Company: Orthopedic Associates of Flower Mound, PLLC
Location: Flower Mound
Posted on: January 22, 2023

Job Description:

SUMMARY: Provides assistance with various healthcare services following established policies and protocols. Proficient in medical billing, coding and working insurance denials.


  • Must be able to appeal denied claims
  • Posting daily insurance payments for 12 providers if needed
  • Ability to verify patient benefits if needed
  • Identify payment trends
  • Monitor allowed amounts
  • Follow-up with insurance companies on outstanding claims
  • Work insurance refund letters
  • Assist with medical record audits from various insurance carriers
  • Ability to communicate with clinical staff
  • Ability to read and understand an explanation of benefits and convey to patient
    • Exhibits a high degree of courtesy, tact, and poise when interacting with patients, families, and other healthcare professionals.
    • Adjusts to fluctuating peaks in patient flow, acuity, and other operational demands while maintaining quality.
      • Performs other related duties as assigned by management.

        • High school diploma.
        • 3+ years of insurance and medical billing experience
        • Complete understanding of managed care products (i.e. PPO, HMO, POS, MEDICARE, Workers Compensation, Medicare Replacement Plans, Exchange Plans)
        • Multi- tasking skills are essential
        • Working knowledge of ICD 10 and CPT Codes
          • Commitment to excellence and high standards
            • Able to work collaboratively with multiple health professionals in a busy and complex environment using tact, diplomacy, and discipline.
            • Ability to understand and adhere to established policies, procedures, and protocols.
            • Ability to manage priorities and workflow
            • Proficient at reading and understanding explanation of benefits
            • Multi-tasking skills are essential

              • Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan.
              • Judgement - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.
              • Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.
              • Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
              • Quantity - Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickly.

                • Occasionally required to stand
                • Occasionally required to walk
                • Continually required to sit
                • Frequently required to utilize hand and finger dexterity
                • Occasionally required to climb, balance, bend, stoop, kneel or crawl
                • Frequently required to talk or hear
                • While performing the duties of this job, the noise level in the work environment is usuallyvery quiet
                  • The employee mustoccasionally lift and /or move more than 5 pounds

                    The above is intended to describe the general content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities or physical requirements. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Keywords: Orthopedic Associates of Flower Mound, PLLC, Flower Mound , Medical Claims and Billing Specialist, Other , Flower Mound, Texas

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