Medical Claims Processor

Long Term Temporary, Possible Temporary- to -Direct Hire Medical Billing / Claims Coordinator - Monday through Friday, 9am to 5pm, Fully On-Site.

• Communicate via telephone and written correspondence with providers, members, attorneys, and collection agencies to resolve balance billing / fee negotiation inquiries.
• Handle large call volume.
• Negotiate and resolve balance billing inquires, negotiate fees and discounts for members with nonparticipating providers to reduce out of pocket expenses.
• Analyze correspondence; verify member eligibility, claim history and coordination of benefits.
• Review claims to determine if appropriate action was taken; follow up with Claims and Recovery Units to initiate adjustments and recover money.
• Identify billing anomalies and alert the Fraud and Abuse Department to reduce fraudulent billing practices.
• Triage balance billing / fee negotiation inquiries and ensure all documents are processed in a timely and efficient manner.
• Research provider contracts and lease network reports to ensure providers are not breaching contracts by referring members out of network.
• Perform additional duties and projects as assigned by management.