Insurance Claims Specialist

Role Overview

• Submits accurate and timely claims to third party payers.
• Resolves claim edits and account errors prior to claim submission.
• Adheres to appropriate procedures and timelines for follow-up with third party payers to ensure collections and to exceed department goals.
• Gathers statistics, completes reports and performs other duties as scheduled or requested.
• Organizes and executes daily tasks in appropriate priority to achieve optimal productivity, accountability and efficiency.
• Complies with Notices of Privacy Practices and follows all HIPAA regulations pertaining to PHI and claim submission/follow-up.
• Contacts third party payers to resolve unpaid claims.
• Utilizes payer portals and payer websites to verify claim status and conduct account follow-up.
• Assists Patient Access and Care Management with denials investigation and resolution.
• Participates in educational programs to meet mandatory requirements and identified needs with regard to job and personal growth.
• Attends department meetings, teleconferences and webcasts as necessary.
• Researches and processes mail returns and claims rejected by the payer.
• Reconciles billing account transactions to ensure accurate account information according to established procedures.
• Processes billing and follow-up transactions in an accurate and timely manner.
• Develops and maintains working knowledge of all federal, state and local regulations pertaining to hospital billing.
• Monitors accounts to facilitate timely follow-up and payment to maximize cash receipts.
• Maintains work queue volumes and productivity within established guidelines.
• Provides excellent customer service to patients, visitors and employees.
• Participates in performance improvement initiatives as requested.

Requirements

• High School diploma or equivalent
• One (1) year medical billing/medical office experience
• Excellent oral and written communication skills
• Knowledge of medical terminology preferred
• Knowledge of business math preferred
• Knowledge of ICD-10 and CPT coding processes preferred

Benefits

• Health insurance
• Paid time off
• Professional development