Job Description

Join to apply for the Medical Claims Integrity Specialist role at Unity Health Care

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Join to apply for the Medical Claims Integrity Specialist role at Unity Health Care

This range is provided by Unity Health Care. Your actual pay will be based on your skills and experience talk with your recruiter to learn more.

Base pay range

$24.95/hr - $31.19/hr

INTRODUCTION

We are searching for a dedicated and detail-oriented Medical Claims Integrity Specialist to join our team. The ideal candidate will have a strong background in medical billing and knowledge of coding, as well as a thorough understanding of insurance policies and procedures. This role involves reviewing and processing medical claims, ensuring accuracy and compliance with all relevant regulations. This position requires excellent communications skills, as well as the ability to work independently and manage multiple tasks simultaneously. The successful candidate will be responsible for maintaining accurate records, identifying discrepancies, and ensuring timely reimbursement of medical services.

Major Duties/Essential Functions

• Review and process both professional and institutional medical insurance claims.
• Process medical claims within established timelines
• Ensure accuracy and compliance with relevant regulations.
• Identify and scrub discrepancies in claims.
• Stay updated on changes in insurance policies and procedures.
• Collaborate with other team members to improve claims processing efficiency.
• Verify patient insurance coverage when needed.
• Participate in audits and quality assurance activities.
• Maintain confidentiality of patient information.
• Adhere to all company policies and procedures.
• Perform other duties as assigned.

Qualifications

• High School diploma or GED required/Associates degree preferred.
• Proficient in ICD 10, CPT, and HCPCS
• Minimum of 4 years of experience in medical claims processing (multi-specialty experience preferred).

Knowledge, Skills, And Abilities Required

• Ability to analyze, identify and resolve any discrepancies during the claims process
• Ability to work in a fast-paced environment
• Strong understanding of medical terminology and insurance policies.
• Excellent analytical and problem-solving skills.
• Attention to detail and accuracy in data entry.
• Ability to work independently and as part of a team.
• Proficient in Microsoft Office Suite and claims processing software.
• Strong communication and interpersonal skills.
• Ability to handle confidential information with discretion.
• Knowledge of regulatory requirements related to health insurance claims.
• Experience with electronic health records (EHR) systems.
• Ability to manage multiple tasks and meet deadlines.
• Strong organizational skills and attention to detail.
• Excellent data Entry
• Commitment to continuous learning and professional development

SUPERVISORY CONTROLS

This position reports directly to the Medical Coding Manager.

GUIDELINES

The position abides by all rules and regulations set forth by applicable licensing and regulatory bodies and the UHC policies and procedures.

PERSONAL CONTACTS

Primary contact is with the employees and potential employees of UHC Health Centers and DOC sites but may also include external customers.

PHYSICAL DEMANDS

Refer to ADA Checklist.

WORKING CONDITIONS AND PHYSICAL EFFORT

Refer to ADA Checklist.

Other Significant Facts

The incumbent must be able to balance the needs of diverse constituencies on a daily basis.

RISKS

The position involves everyday risk and discomforts, which require normal safety pre-cautions typical of such places as offices, meetings, training rooms, and other UHC health Care Sites. The work area is adequately lit, heated, and ventilated. The position requires contact with staff at all levels throughout the organization. There are also external organization relationships that may be part of the work of this individual. All medical services shall be provided according to medically accepted community standards of care. The employee shall provide evidence of recent (within the past twelve (12) months) health assessment that includes a PPD and/or chest x-ray results.

The statements contained herein describe the scope of the responsibility and essential functions of this position, but should not be considered an all-inclusive listing of work requirements. Individuals may perform other duties as assigned including work in other areas to cover absences or relief to equalize peak work periods or otherwise balance the workload.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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Job Tags

Full time, Work at office,

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