
Medical Claims Specialist
3 days ago
This is a full-time onsite position requiring the selected candidate to work night shifts aligned with U.S. Central Time (7 PM – 4 AM PKT). The role involves managing end-to-end billing operations for psychiatry and behavioral health services under the U.S. healthcare system.
Key Responsibilities:- Claims Preparation and Submission: Prepare, review, and submit accurate claims for psychiatry services (individual therapy, medication management, psychiatric evaluations, etc.). Ensure accurate use of CPT, ICD-10, and HCPCS codes, including psychiatry-specific codes such as 90791, 90833, 90834, 90837, 99213, 99214.
- Claims Management: Submit electronic and paper claims to commercial insurance, Medicare, and Medicaid. Conduct follow-ups on pending claims and aged AR to secure timely reimbursements.
- Denial Resolution and Payment Posting: Investigate and resolve denials and rejections, identifying root causes and resubmitting corrected claims. Post payments (ERA/EOB), reconcile billing records, and apply appropriate adjustments or write-offs.
- Billing Discrepancies and Compliance: Collaborate with internal teams and providers to resolve billing discrepancies and obtain missing documentation. Maintain compliance with HIPAA regulations and payer-specific psychiatry billing guidelines.
- Performance Tracking: Prepare billing status reports and assist the team lead with performance tracking.
- Education: Intermediate/A-levels and/or Bachelor's degree in Healthcare Administration, Finance, or a related field (preferred).
- Experience: Minimum 1–2 years of hands-on experience US Medical Billing.
- Availability: Available to work night shifts aligned with U.S. Central Time (7 PM – 4 AM PKT)
- Skillset: Solid understanding of the end-to-end RCM process specific to mental health services. Proficient in EMRs and billing platforms (e.g., CMD). Solid knowledge of psychiatry-specific billing codes, modifiers, and insurance protocols.
- Communication Skills: Strong communication and documentation skills in English. Proficiency in MS Excel, Google Sheets, and reporting tools.
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