Medical Payment Specialist

Note: This is a remote position with mandatory once a month team meeting in the office.

Job Description:
This position is responsible for reviewing and adjudicating complex medical bills and responding to inquiries from internal/external customers. Handles customer appeals and disputes of payments and pre-certifications within Client Casualty Services, Inc.

Job Description:

Reviews and adjudicates complex medical bills in accordance with established policies and procedures.
Posts approved bills for payment, and issues Explanation of Benefits (EOB) for denied payments.
Responds to internal/external inquiries regarding the status of medical bills.
Acts as information resource to Medical Consultants for policy determination.
Assists in gathering/providing information for resolution of medical bill payment disputes and provider appeals.
Completes other assigned functions as requested by Management.
Education/Experience:
Requires High School diploma or GED equivalent.
Prefers Bachelor's degree.
Requires a minimum of 2-3 years of experience adjudicating medical bills.
Prefer work experience in a property and casualty insurance environment.
Knowledge:
Requires working knowledge of personal computers and supporting software in windows based environment including MS Office Products and email application systems.
Requires knowledge of medical terminology.
Requires knowledge of medical bill adjudication process.
Requires knowledge of applicable laws and regulations regarding medical bill adjudication.
Prefers knowledge of NJ Workers' Compensation and No-Fault laws.
Skills and Abilities:
Requires strong mathematical skills.
Attention to Detail
Decision Making
Communication & Organizational Skills
Flexibility/Adaptability
Planning/Priority Setting
Teamwork
Note: This is a remote position with mandatory once a month team meeting in the office.