Medical Claims Specialist

6 days ago

Toronto, Ontario, Canada RT Medical Full time
Job Summary:

The Medical Billing Specialist is a key member of our team at RT Medical, responsible for ensuring accurate and timely processing of patient billing information, insurance claims, and payments. This role requires a strong understanding of medical billing procedures, insurance guidelines, and regulatory requirements in Ontario.

Key Responsibilities:
  1. Billing and Coding:
  • Accurate Data Entry: Enter patient billing information into our electronic health records (EHR) system with precision and attention to detail.
  • Medical Coding: Assign accurate medical codes (ICD-10, CPT) to diagnoses and procedures, ensuring compliance with regulatory requirements.
  • Verification and Review: Verify patient information for completeness and accuracy, ensuring that all necessary details are captured.
  1. Insurance Claims Management:
  • Claims Submission: Submit insurance claims to appropriate payers, including provincial health insurance (OHIP & WSIB) and private insurers, ensuring timely processing and payment.
  • Claims Resolution: Follow up on unpaid or denied claims to ensure timely resolution and minimize delays.
  • Communication: Communicate with insurance companies to clarify billing discrepancies and resolve issues, ensuring seamless claims processing.
  1. Payment Processing:
  • Payment Posting: Post payments received from insurance companies and patients to the appropriate accounts, ensuring accurate recording and reconciliation.
  • Account Reconciliation: Reconcile accounts to ensure accurate and complete recording of transactions, identifying and resolving any discrepancies.
  • Invoice and Statement Preparation: Prepare and send patient invoices and statements, ensuring timely and accurate communication.
  1. Compliance and Documentation:
  • Regulatory Compliance: Maintain compliance with healthcare regulations, including privacy and confidentiality standards, ensuring the security and integrity of patient data.
  • Regulatory Updates: Stay up-to-date with changes in billing regulations and insurance policies, ensuring that our processes remain compliant and effective.
  • Documentation: Ensure accurate and complete documentation of billing activities, providing a clear audit trail and facilitating efficient claims processing.
  1. Reporting and Analysis:
  • Reporting: Generate billing and financial reports for management review, providing insights into our revenue cycle performance.
  • Data Analysis: Analyze billing data to identify trends and areas for improvement, informing process enhancements and optimization.
  • Process Improvement: Provide recommendations for optimizing billing processes, ensuring that our operations remain efficient and effective.
Qualifications:
  • Diploma or certificate in medical billing, health administration, or a related field.
  • Medical Terminology course preferred.
  • Minimum of 2 years of experience in medical billing or a similar role in Ontario.
  • Relevant healthcare and/or registration experience preferred.
  • Knowledge of medical coding systems (ICD-10, CPT) and billing software.
  • Familiarity with OHIP & WSIB billing procedures and guidelines.
  • Strong attention to detail and accuracy.
  • Excellent communication and interpersonal skills.
  • Proficiency in Microsoft Office Suite and EHR systems.
  • Experience in electronic medical records systems preferred.
  • Ability to manage multiple tasks and meet deadlines.
Benefits:
  • Competitive salary and benefits package.
  • Opportunities for professional development and advancement.
  • Collaborative and supportive work environment.
  • Commitment to work-life balance.

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