Claims Submission: Prepare, review, and submit claims for diagnostic lab services to commercial and government payers, ensuring compliance with payer guidelines and laboratory policies.
Denial Management: Analyze denied claims, identify root causes, and initiate corrective actions including appeals and resubmissions.
Follow-Up: Proactively follow up on outstanding claims, monitor aging reports, and communicate with payers to resolve issues and expedite payment.
Documentation: Maintain accurate records of claim status, correspondence, and payer responses in the billing system.
Collaboration: Work closely with prior authorization, billing, and reimbursement teams to resolve complex claims and support cross-functional RCM initiatives.
Compliance: Stay current with payer requirements, coding updates (CPT, ICD-10), and regulatory changes affecting laboratory claims.
Reporting: Generate and analyze claims performance reports to identify trends, opportunities for process improvement, and support management decision-making.

Associate’s or Bachelor’s degree in healthcare administration, business, or related field (preferred).
2+ years of experience in medical claims processing, preferably in a diagnostic laboratory or healthcare setting.
Strong knowledge of insurance billing, payer requirements, and denial management.
Familiarity with laboratory coding (CPT, ICD-10), EOBs, and remittance advice.
Proficiency with billing software and Microsoft Office Suite.
Excellent attention to detail, organizational, and communication skills.
Ability to work independently and collaboratively in a fast-paced environment.

Claims Specialist

Key skills