Medical Claims Specialist

u003cpu003eu0026 u003c/pu003eu003chru003eu003ch2u003eu003cstrongu003eMedical Claimsu0026 Specialistu003c/strongu003eu003c/h2u003eu003ch3u003eu003cstrongu003eCompany Overviewu003c/strongu003eu003c/h3u003eu003cpu003eOur client is the national leader in the delivery of superficial radiation therapy services. With partnerships at more than u003cstrongu003e300 practicesu003c/strongu003e across the United States and generating over u003cstrongu003e$130 million in revenueu003c/strongu003e, the company is experiencing rapid growth and offers tremendous opportunities for professional development and career advancement.u003c/pu003eu003ch3u003eu003cstrongu003eJob Summaryu003c/strongu003eu003c/h3u003eu003cpu003eWe are seeking a u003cstrongu003edetail-oriented and knowledgeable Medical Claimsu0026 Specialistu003c/strongu003e to join our dynamic team. This role is responsible for reviewing, analyzing, and resolving denied medical claims to ensure accurate reimbursement and compliance with payer guidelines. The ideal candidate has a strong understanding of medical billing and coding, insurance policies, and the appeals process, along with excellent analytical, technical, and communication skills.u003c/pu003eu003ch3u003eu003cstrongu003eKey Responsibilitiesu003c/strongu003eu003c/h3u003eu003culu003eu003cliu003eu003cpu003eReview and analyze denied or underpaid claims to determine the root cause and take appropriate corrective action.u003c/pu003eu003c/liu003eu003cliu003eu003cpu003eInterpret u003cstrongu003eExplanation of Benefits (EOBs)u003c/strongu003e, denial codes, and payer guidelines to identify trends and solutions.u003c/pu003eu003c/liu003eu003cliu003eu003cpu003eResearch and resolve claim denials through u003cstrongu003eappeals, corrections, and additional documentationu003c/strongu003e, ensuring timely follow-up.u003c/pu003eu003c/liu003eu003cliu003eu003cpu003eSubmit u003cstrongu003ecorrected claimsu003c/strongu003e for issues such as missing CPT codes, incorrect provider information, or coding adjustments.u003c/pu003eu003c/liu003eu003cliu003eu003cpu003eApply appropriate u003cstrongu003eCPT modifiersu003c/strongu003e when unbundling office visits with procedures or treatments, in accordance with payer policy.u003c/pu003eu003c/liu003eu003cliu003eu003cpu003eManage day-to-day u003cstrongu003eaccounts receivable (A/R)u003c/strongu003e processes, including prioritizing claims from aging reports.u003c/pu003eu003c/liu003eu003cliu003eu003cpu003eUse u003cstrongu003eExcelu003c/strongu003e to review, organize, and analyze aging data; filter or create pivot tables to track claim status and trends.u003c/pu003eu003c/liu003eu003cliu003eu003cpu003eUtilize u003cstrongu003eEHR/EMR systems, billing platforms, and clearinghousesu003c/strongu003e to process and track claims; troubleshoot clearinghouse rejections or errors.u003c/pu003eu003c/liu003eu003cliu003eu003cpu003eCommunicate with payers, providers, and internal departments to obtain and clarify necessary information.u003c/pu003eu003c/liu003eu003cliu003eu003cpu003eStay current on changes in medical coding, payer rules, and billing requirements.u003c/pu003eu003c/liu003eu003cliu003eu003cpu003eMaintain compliance with u003cstrongu003eHIPAAu003c/strongu003e and all regulatory guidelines.u003c/pu003eu003c/liu003eu003cliu003eu003cpu003eIdentify and report recurring denial patterns to support process improvement and reduce future denials.u003c/pu003eu003c/liu003eu003cliu003eu003cpu003eContribute to team collaboration and maintain professionalism in all communications.u003c/pu003eu003c/liu003eu003c/ulu003eu003ch3u003eu003cstrongu003eRequired Skills u0026Qualificationsu003c/strongu003eu003c/h3u003eu003culu003eu003cliu003eu003cpu003eStrong understanding of medical billing, u003cstrongu003eICD-10, CPT, and HCPCSu003c/strongu003e coding.u003c/pu003eu003c/liu003eu003cliu003eu003cpu003e2+ years of experience in u003cstrongu003emedical claims, billing, or denial managementu003c/strongu003e.u003c/pu003eu003c/liu003eu003cliu003eFamiliarity with u003cstrongu003eCMS-1500 and UB-04 claim formsu003c/strongu003e.u0026 u003c/liu003eu003c/ulu003eu003cdivu003eu0026 u003c/divu003eu003culu003eu003cliu003eWorking knowledge of u003cstrongu003einsurance plansu003c/strongu003e (Medicare, Medicaid, commercial payers) and u003cstrongu003eappeals processesu003c/strongu003e.u003c/liu003eu003cliu003eu003cpu003eExperience interpreting u003cstrongu003eEOBsu003c/strongu003e and working with u003cstrongu003ecorrected claimsu003c/strongu003e.u003c/pu003eu003c/liu003eu003cliu003eu003cpu003eProficiency with u003cstrongu003eEHR/EMR systemsu003c/strongu003e (e.g., Epic, Cerner) and u003cstrongu003eclearinghouse processesu003c/strongu003e.u003c/pu003eu003c/liu003eu003cliu003eu003cpu003eSkilled in u003cstrongu003eMicrosoft Excel and Office Suiteu003c/strongu003e, including sorting, filtering, and analyzing claim data.u003c/pu003eu003c/liu003eu003cliu003eu003cpu003eStrong analytical, problem-solving, and organizational skills with attention to detail.u003c/pu003eu003c/liu003eu003cliu003eu003cpu003eExcellent written and verbal communication skills.u003c/pu003eu003c/liu003eu003cliu003eu003cpu003eAbility to work independently and manage multiple priorities effectively.u003c/pu003eu003c/liu003eu003cliu003eu003cpu003eKnowledge of u003cstrongu003eHIPAAu003c/strongu003e regulations and healthcare compliance standards.u003c/pu003eu003c/liu003eu003c/ulu003eu003ch3u003eu003cstrongu003ePreferred Qualificationsu003c/strongu003eu003c/h3u003eu003culu003eu003cliu003eu003cpu003eCertified coder or biller (Dermatology certification preferred).u003c/pu003eu003c/liu003eu003cliu003eu003cpu003eExperience in a u003cstrongu003eprovider office, oncology, or third-party billing environmentu003c/strongu003e.u003c/pu003eu003c/liu003eu003cliu003eu003cpu003eKnowledge of insurance verification, benefits, and referrals.u003c/pu003eu003c/liu003eu003cliu003eu003cpu003eDemonstrated ability to learn and adapt to new billing or EHR systems quickly.u003c/pu003eu003c/liu003eu003c/ulu003eu003ch3u003eu003cstrongu003eBenefits u0026Work Environmentu003c/strongu003eu003c/h3u003eu003culu003eu003cliu003eu003cpu003eCompetitive salary, commensurate with experience.u003c/pu003eu003c/liu003eu003cliu003eu003cpu003eComprehensive benefits package including u003cstrongu003emedical, dental, vision, life, disability insuranceu003c/strongu003e, and u003cstrongu003e401(k) with company matchu003c/strongu003e.u003c/pu003eu003c/liu003eu003cliu003eu003cpu003eu003cstrongu003e15 days PTOu003c/strongu003e in the first year plus u003cstrongu003e10 paid holidaysu003c/strongu003e.u003c/pu003eu003c/liu003eu003cliu003eu003cpu003eu003cstrongu003eHybrid work scheduleu003c/strongu003e - work from home two days per week.u003c/pu003eu003c/liu003eu003cliu003eu003cpu003eOffice with a u003cstrongu003elaid-back, collaborative environmentu003c/strongu003e and a casual dress code.u003c/pu003eu003c/liu003eu003c/ulu003eu003cpu003eIf you are a motivated and skilled Claims Integrity Specialist with a passion for accuracy, compliance, and improving revenue cycle performance, we encourage you to apply and become part of our growing team.u003c/pu003eu003chru003eu003cpu003eu0026 u003c/pu003eu003cpu003eu0026 u003c/pu003e ', 'location ': 'Burr Ridge, IL ', 'remote ':null, 'jobtype ': 'directhire ', 'remoteoption ': 'hybrid ', 'featuredonjobboard ':false, 'ownedbyagency ':false, 'externalid ': 'IL152-2727064

Created: 2026-03-07