Tal Healthcare
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USD
60000
60000
YEAR
true
Medical Billing Specialist
515 Hempstead Turnpike
West Hempstead,
NY
11552
US
2025-01-06
2025-06-14
Department: Revenue
Job Number: 6498
Pay Rate: $60000-60000
Employment Type: Full Time
Job Description
Our client, a national company servicing medical across the county and NY is seeking a Medical Billing and Follow-up Specialist.
Responsibilities:
- Creates and manages submission, intervention and resolution of bills, appeals, and grievances both electronically and manually
- Conducts pertinent research, evaluates, responds and completes appeals and other insurance/policy guideline inquiries accurately, timely and in accordance with all established regulatory guidelines.
- Prepares appeal documentation, summaries, correspondence, as well as documents information for tracking/trending data.
- Review denied insurance claims, identify and resolve the issues in order to resubmit.
- Develop strategies to reverse claim denials.
- Manage and organize appeal workflow based on internal and insurance-driven deadlines.
- Researches insurance policy language to determine medical necessity criteria.
- Request and obtain medical records, notes, and/or detailed bills as appropriate to assist with research.
- Collaborates with other team members to determine appropriate responses.
- Prepare documentation for submitting bills/grievances/appeals.
- Maintains current knowledge of regulatory billing requirements.
- Monitors and tracks the number of appealed claims.
- Assure timeliness and appropriateness of all appeals according to state, federal, and company guidelines.
- Position can be a hybrid, two or three days in office.
Required Experience:
- Prior experience in the creation, submission, and completion of all hospital bills and insurance appeals.
- Office administrative experience and the ability to work independently while effectively researching and maintaining the most current government laws and patterns of insurance denial, etc.
- Familiarity with Commercial Insurance, Medicaid and Medicare claims denials and appeals processing, and knowledge of NCCI guidelines and LCD/NCD Edits for appeals and denials.
- Familiarity with the Tri State Area Payers and Fiscal intermediary necessary
Desired Skills:
- Computer literacy, especially with MS Office
- Knowledge of Medicare and Medicaid rules and regulations.
- Efficient multi-tasking.
- Strong organizational skills
- Ability to prioritize workload based on strict deadlines.
- Attention to detail.
- Effective organization of work assignments.
- Effective written and oral communication.
- Ability to self-motivate and learn quickly.
- Ability to review and understand insurance policy language and guidelines.
- Understand and comply with HIPAA regulations.
Salary: The posted range is not a guarantee. The actual salary will be based on qualifications, experience, and education and could fall outside of this range. Contact us for more information.
#LI-FP1
Meet Your Recruiter
Fran Philips
Vice President, Healthcare Recruitment
Fran is a seasoned recruiter who joined Tal in 2008, after a long career in medical billing for multi-specialty practices including dermatology, dental, and ophthalmology.
Learn more about Fran, Tal Healthcare Employee Biography
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Medical Billing Specialist
515 Hempstead Turnpike West Hempstead, NY 11552 US
Job Description
Responsibilities:
- Creates and manages submission, intervention and resolution of bills, appeals, and grievances both electronically and manually
- Conducts pertinent research, evaluates, responds and completes appeals and other insurance/policy guideline inquiries accurately, timely and in accordance with all established regulatory guidelines.
- Prepares appeal documentation, summaries, correspondence, as well as documents information for tracking/trending data.
- Review denied insurance claims, identify and resolve the issues in order to resubmit.
- Develop strategies to reverse claim denials.
- Manage and organize appeal workflow based on internal and insurance-driven deadlines.
- Researches insurance policy language to determine medical necessity criteria.
- Request and obtain medical records, notes, and/or detailed bills as appropriate to assist with research.
- Collaborates with other team members to determine appropriate responses.
- Prepare documentation for submitting bills/grievances/appeals.
- Maintains current knowledge of regulatory billing requirements.
- Monitors and tracks the number of appealed claims.
- Assure timeliness and appropriateness of all appeals according to state, federal, and company guidelines.
- Position can be a hybrid, two or three days in office.
- Prior experience in the creation, submission, and completion of all hospital bills and insurance appeals.
- Office administrative experience and the ability to work independently while effectively researching and maintaining the most current government laws and patterns of insurance denial, etc.
- Familiarity with Commercial Insurance, Medicaid and Medicare claims denials and appeals processing, and knowledge of NCCI guidelines and LCD/NCD Edits for appeals and denials.
- Familiarity with the Tri State Area Payers and Fiscal intermediary necessary
- Computer literacy, especially with MS Office
- Knowledge of Medicare and Medicaid rules and regulations.
- Efficient multi-tasking.
- Strong organizational skills
- Ability to prioritize workload based on strict deadlines.
- Attention to detail.
- Effective organization of work assignments.
- Effective written and oral communication.
- Ability to self-motivate and learn quickly.
- Ability to review and understand insurance policy language and guidelines.
- Understand and comply with HIPAA regulations.
#LI-FP1
Meet Your Recruiter
Fran Philips
Vice President, Healthcare Recruitment
Fran is a seasoned recruiter who joined Tal in 2008, after a long career in medical billing for multi-specialty practices including dermatology, dental, and ophthalmology.
Learn more about Fran, Tal Healthcare Employee Biography