Medical Claims Specialist II

Position Summary

Qualifies orders on shipment pending for placement authorization payerCoordinate all paperwork required for shipping of product and billing of claims.

Releases orders for delivery and claims for billing.

Call customer or field personnel to obtain missing documents previously requested by the Call Center Representative or missing on faxed order.

Act as a contact person for the field personnel, medical professionals, and claims

carriers to facilitate the organization of paperwork required for the processing of

claims.

Ensure accuracy of incoming medical documentation and note acceptance in

system.

Refer complex clinical, product, or patient questions to the Clinical Specialist.

Review all incoming claims-related paperwork for completeness; follow up on

missing information to ensure claims are forwarded for processing in a timely

manner.

Obtain recertification information and documentation for payers as required.

Contact appropriate carriers and sales personnel for supplemental information of

documentation requirements.

Evaluate orders on shipment pending within two hours of entry.

Determine actions based on payer source.

Ensure all payer and internal requirements are met for each order.

Properly document above.

Release orders for delivery.

Notify appropriate field personnel of order status and special instructions.

Track order until payer and internal requirements are met for billing.

Document and notify appropriate personnel of billing, pricing, and other order-

specific information.

Assist with the recertification procedure.

Perform reporting as required.

Maintain courteous and timely communication with all customers at all times.

Return messages within one hour of receipt.

Participates in any and all reasonable work activities as may be deemed suitable

and assigned by management.

Conforms to, supports and enforces all Company policies and procedures.
REQUIREMENTS


Job Requirement



Two years or more medical front office or benefit/claim processing experience.

Personal computer skills.

Excellent telephone customer service skills.

Demonstrates good problem-solving skills.

Achieves passing scores on pre-employment skills tests.

Willingness and ability to participate in all required training programs.

Ability to work effectively in a team environment, as well as, independently.

Ability to deal effectively with all employees and external business contacts while

conveying a positive, service-oriented attitude.

Ability to communicate effectively, both verbally and in writing.

Ability to maintain complete confidentiality and discretion in business relationships

and exercise sound business judgment.