Insurance Claim 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.
• Gathers statistics, completes reports and performs other duties as scheduled or requested.
• Organizes and executes daily tasks to achieve optimal productivity, accountability, and efficiency.
• 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.
• Researches and processes mail returns and claims rejected by the payer.
• Reconciles billing account transactions to ensure accurate account information.
• Maintains work queue volumes and productivity within established guidelines.
• Communicates problems hindering workflow to management in a timely manner.

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

• Excellent customer service
• Professional development
• Confidentiality according to policy