Claims Review Specialist

Physicians Resources, Ltd. was established in 1985 and offers a full billing service and practice management consultation.  Our mission is to provide our clients with loyalty, personal focus, innovation and a compelling experience. To exceed our clients’ expectations, not just meet them. To build long-term relationships by promoting open interaction and continued communication, while providing a personalized experience. Our environment continues and always will be customer focused.

Reports to: Accounts Receivable Manager

Position Overview: The Accounts Receivable role requires broad knowledge of the medical billing cycle and is crucial to the client's revenue stream

Position Responsibilities;

• Maintaining receivables for assigned clients in a timely manner
  
  
  
  • Assigned clients are worked in a 5 week cycle, including aging reports, paper eobs, and other duties as assigned.
    
  • Work with clients, insurance reps, and patients to resolve outstanding charges, re-filing claims/appeals and submitting to management charges that are not payable.
    
  • Use all available resources (internet, provider manuals, home page info, and team members) to research and resolve claims issues, escalating issues as needed.
    
  • Maintain client databases
  
  
• Providing feedback to management and billing staff on reimbursement issues:
  
  
  
  • Communicate denial trends with team to prevent further denials.
    
  • Suggesting process changes to improve work flow.
    
  • Be a resource to team members on claims issues

Required Skills & Experience:

• Have familiarity with medical billing including CPT/HCPCS coding, modifier use, benefit design, credentialing, utilization review, state laws, etc.
  
• Knowledge of Ntierprise (Allscripts) software and Medisense aplus.

• Have general knowledge of a wide range of specialties
  
• Be experts in the claims process for a variety of insurance carriers, including WC and government plans such as Medicare and Medicaid
  
• Use good judgment as it pertains to time management and claims analysis
  
• Consider the cost/benefit analysis of resubmitting claims and know when to cut losses

Physicians Resources, LTD is a growing Company that offers a challenging and exciting work environment.  We offer competitive salaries and benefits package.  We offer a team environment that encourages personal and professional growth.  Qualified candidates should forward their resumes with salary requirements. 

Physicians Resources LTD is an equal opportunity employer