If you are interested in joining the SunStone Consulting team, please send your resume to inquiries@sunstoneconsulting.com.

 

Current Openings

 
 

Medical Claims Specialist 

A medical claims specialist is responsible for submitting medical claims to insurance companies for payment to the medical provider for services rendered. Our immediate need is for Medical Claims Specialists for our Pennsylvania Workers’ Compensation and Auto billing and collection outsourcing practice. 

The general responsibilities of the Medical Claims Specialist include: 

  • verifying patients’ employer and workers’ compensation/auto insurance coverage, 

  • confirming that all required data elements have been completed on the claim forms, 

  • compiling all the necessary documents to submit a medical claim, including the UB04 claim form, detailed bill, relevant sections of the patient’s medical record and the medical report form. 

  • ability to work with insurance adjusters and other personnel to expedite medical claim payments. 

  • discuss underpayments with insurance companies and resolving those underpayments. 

  • file an Application for Fee Review with the Pennsylvania Bureau of Workers’ Compensation for any disputes that cannot be resolved directly with the insurance company. 

  • document the patients account in the medical providers system to reflect all updates and conversations with insurance companies. 

The candidate should have solid time management and documentation skills and be a detail-oriented person. Also, an understanding of HIPPA and PHI guidelines, excellent customer service skills and telephone skills, and be familiar medical terminology and medical insurance codes. Familiarity with Microsoft Office products is required, especially Microsoft Word and Excel. Location is in the Newtown Square, PA area. 

Prior experience a plus but not required. 

Job Type: Full-time 

Medical Billing Supervisor

Overview:  We are seeking a qualified and dedicated medical biller/analyst to join our reimbursement and revenue consulting practice

Job Type:  Full-time

Job Description

This person will be responsible for a variety of tasks requiring data analysis, evaluation, and judgment.  To succeed in this position, the candidate must possess a working knowledge of billing software, medical insurance contracts, and be able to demonstrate excellent written and verbal communication skills. Communication with other consulting team members, clients, and insurance representatives will form a large part of the day to day functions.  Primary duties for this position will include the following:

  1. Working with various billing software applications

  2. Submitting Medicare and managed care claims and adjustment claims

  3. Tracking insurer payments and analyzing contractual allowances

  4. Pursuing denied claims through electronic and written appeal

  5. Conducting follow-up and resolution with insurers

  6. Performing medical record analysis

  7. Analyzing patient benefit eligibility information

 

Desired Experience

  1. A minimum of five years of experience as a medical inpatient biller in a high-volume healthcare setting.  Strong desire for supervisory experience

  2. Thorough understanding of Medicare and managed care insurer billing, reimbursement and terminology

  3. Proficient with Microsoft Office products including Excel and Teams

  4. Familiarity with Medicare DDE/FSS0/HETS systems

  5. EPIC and/or other third-party billing systems

  6. Must have the ability to work independently, mentor others and manage time effectively