Medical Claim and Denial Specialist - Port Saint Lucie, FL (Hybrid)

ABC Home Medical Supply, Inc is one of the nation’s leading urological supply providers and serves as a one-stop shop with a comprehensive line of medical supplies and service that includes: Urological, Incontinence, Wound Care, and Ostomy.  ABC Medical is part of the JDS, Inc family of businesses.  Our service companies possess the knowledge and expertise to deliver first-class products and personalized home healthcare services.

Location: Port Saint Lucie 
Department:  

Work Location Information:

Port Saint Lucie, FL

Hybrid Schedule: Onsite Thursday and Friday

Work Hours: 8:30am-5pm EST

Responsibilities:

The Medical Claim and Denial Specialist is responsible for generating revenue by the timely processing and submission of clean medical claims to all payers including insurance companies, federally subsidized government plans such as Medicare Parts B and C, Medicaid, Medicaid Managed, as well as patient billing. The Medical Claim and Denial Specialist is also responsible for reviewing reports/work queues to identify and to correct the root cause for claim rejections, and denials which might prevent or delay payment of a particular claim or group of claims. 

• Review claims for accuracy prior to claim submission.
• Ensures the required supporting documentation is on file prior to claim submission as determined by the company and/or the insurance plan/government payer.
• Identifies and resolves claim rejections and denials.
• Mark accounts for no bill when irregular conditions cannot be resolved before billing/timely filing date.
• Identification and recommendation for resolution for payer trends preventing or delaying payment working with management to resolve.
• Submit accurate electronic and CMS 1500 paper claims in accordance with company and payer guidelines.
• Adhere to established productivity and quality thresholds.
• Provides recommendations for continued improvement to the billing process.

Minimum Qualifications:

• High School diploma
• 1-3 years of medical billing experience within denials collections area
• Experience billing commercial insurance, Medicare parts B and C as well as Medicaid claims
• Possess a working knowledge of the payer’s appeals process
• Detail oriented individual with customer service experience
• Proficiency with Microsoft Office including Excel

Preferred Qualifications:

• Durable Medical Equipment experience
• Experience & knowledge of Brightree billing software preferred or billing/denials software

Here’s what we have to offer:

• Variety of Medical, Dental and Vision Insurance Plans
• 401k Plan with Company Match
• PTO and Paid Holidays
• EAP
• Employee Discounts

Job Req ID: 33132