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Medical Claims Rep - Blue Cross-Blue Shield

Atrius Health – Chelmsford, MA

Atrius Health is a nonprofit healthcare leader delivering a system of connected care that enables us to know our patients better so that we can serve them well. Across 32 clinical locations, more than 50 specialties and 825 physicians, we provide proactive, customized care to more than 720,000 adult and pediatric patients across eastern Massachusetts. The Atrius Health practices including Dedham Medical Associates, Granite Medical Group, Harvard Vanguard Medical Associates and PMG Physician Associates together with VNA Care work in collaboration with hospital partners, community specialists and skilled nursing facilities, to develop innovative and effective ways of delivering care in the most appropriate setting, making it easier for patients to be healthy.

Under general supervision, the Medical Claims Rep - Blue Cross-Blue Shield is responsible for the follow-up and resolution of all outstanding unpaid balances for the assigned insurance payer(s). In accordance with department policies and procedures, responsibilities include but are not limited to: responding to payer correspondence, submitting appeals for denied claims, processing requests for insurance payment retractions, researching and resolving overpayments and investigating electronic claim rejections. Typically reports to Patient Billing Supervisor.


  • Up to 8% company retirement contribution,
  • Generous Paid Time Off
  • 10 paid holidays,
  • Paid professional development,
  • Competitive health and welfare benefits package.


  • Investigates and resolves billing problems using various data and informational sources on hand including computer reports, explanation of benefit material, phone inquiries, and web site inquiries.
  • Investigates non-payment of outstanding balances for assigned insurance payer(s) and resolves, updates, and re-bills or appeals as appropriate using correct HCPCS, ICD.9, and CPT 4 coding and the proper application of modifiers. This includes working, processing, and completing monthly assignments for all accounts.
  • Answers phone calls or responds to e-mails from patients, insurance carriers, practice staff, clinicians and other customers, updates charges and information as indicated.
  • Performs denial posting on accounts as needed.
  • Re-distribute posted payments to correct procedures as indicated.
  • Initiates and responds to refund/take back request to insurance company using the proper forms and documentation.
  • Initiates adjustments on unpaid balances in accordance with department policies and procedures and consult with supervisor when appropriate.
  • Contacts patients, insurance carriers, practice staff, clinicians and other customers for any missing or erroneous information in an effort to obtain more specific information on denial, update and process as necessary.
  • Process/Update provider referrals and primary care information for both paper and electronic claims.
  • investigates electronic claim rejections to update claims information as appropriate.
  • Remains knowledgeable and current on third-party billing procedures, follow-up, and appeals processes, requirements and regulatory guidelines at the federal, state and local levels for all assigned payers.
  • Performs all job functions in compliance with applicable federal, state, local and practice policies, procedures and regulations
  • Performs other duties as needed. Any other duties performed, which are not listed above, are considered non-essential functions


  • 2+ years of physician medical billing, insurance carrier or related physician office experience.
  • High School Diploma or equivalent
  • Proven knowledge of third-party billing rules and regulations, claims resolution and working knowledge of HCPCS, ICD-9, and CPT-4 coding.
  • Knowledge and experience with medical terminology, strong computer skills, and good verbal and written communication skills are necessary.
  • Attention to detail, analytical and problem-solving skills and flexibility in adapting to changes in policies, regulations, and procedures are essential.

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Job Type: Full-time

Salary: $36,838.16 to $46,047.70 /year


  • physician medical billing, insurance carrier: 2 years (Required)
  • claims resolution: 1 year (Required)
  • HCPCS, ICD-9 and CPT-4 coding: 1 year (Required)
  • third party billing rules and regulations: 1 year (Required)


  • High school or equivalent (Required)

Job distance:

  • Chelmsford, MA: Between 31 and 40 miles (Preferred)

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