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

 

MEDICAL CLAIMS SPECIALIST

 

The Medical Claims Specialist position is part of SunStone Consulting’s Pennsylvania Workers’ Compensation and Auto billing and collection outsourcing practice.  Medical Claims Specialists are responsible for submitting medical claims to insurance companies for payment to the medical provider for services rendered. This position will routinely communicate with clients, insurance adjusters, insurance providers, and others to complete a variety of time-sensitive tasks within required deadlines. The Medical Claims Specialist is a hybrid position that will be required to work on-site in York, PA or Lancaster, PA several days each week.  The ideal candidate should have solid time management and documentation skills, strong attention to detail, understanding of HIPPA and PHI guidelines, excellent customer service skills, and familiarity with medical terminology and medical insurance codes. Experience with Microsoft Office products is required, especially Microsoft Word and Excel. Locations in Pennsylvania include York and Lancaster area.

 

Essential functions: 

  • Routinely achieving an average goal of 195-215 claims (i.e. billed, documented, adjusted, refunded, denied, etc.) per day.

  • Regularly communicating with clients and managing client work queues.

  • Verifying patients’ employer and workers’ compensation/auto insurance coverage.

  • Reviewing and 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.

  • Effectively communicating with insurance adjusters and other personnel by phone, fax, e-mail, and postal mail to expedite medical claim payments.

  • Effectively and timely communicating with insurance companies by phone, fax, e-mail, and postal mail to resolve underpayments.

  • Filing Application for Fee Reviews with the Pennsylvania Bureau of Workers’ Compensation for any disputes that cannot be resolved directly with the insurance company within the required timeframe.

  • Timely and accurately documenting patient accounts in the medical provider system to reflect all updates and conversations with insurance companies.

  • Following the guidelines established by the Health Insurance Portability and Accountability Act (HIPAA) for protecting sensitive health information.