CLINIC MSO

• The Claims Billing Specialist handles 35-40 calls daily
• Document all incoming calls following HIPAA guidelines in handling patient data
• Support the claims department by preparing claim receipts and correspondences received in the Hoag Clinic MSO mailroom
• Assist with daily pick-ups and distribution of mail and correspondences from dedicated post office boxes, fax machines, e-fax, secure file transfers, as well as sending provider EOBs, member letters, misdirected claims, and other letters sent by the Claims team
• Interact in a positive and collaborative manner with internal and external partners especially in demanding and tense situations with providers and patients exhibiting a caring, empathetic, and patient attitude
• Support the claims team in implementing initiatives in improving claims processing efficiency
• Assist in provider customer service, member services, health plan, and other customers including making and answering phone calls to providers/billing offices when necessary, based on team guidelines

Education and Experience Required:

• High School Diploma or equivalent, 1+ years of experience in medical claims/billing
• Proficient in Microsoft Word, Excel, Typing/Data Entry
• Billing Specialist only
• Experience in and knowledge of all medical billing protocols including HCPCS, ICD-10, and CPT codes as well as EMR system experience

• The Claims Billing Specialist is responsible for responding to inquiries related to claims, eligibility, and authorization and working with multiple parties to ensure records are up to date.
• Ensures accuracy, reports issues and works to resolve.
• Ensures compliance and regulatory guidelines and health plan requirements are met.
• Documents actions taken following HIPAA guidelines.
• May assist in providing customer service, member services, and others in working with providers/billing offices when needed.
• Performs other duties as assigned.