Insurance Claims Specialist PB

About the role

The successful candidate will manage patient account balances, ensuring accurate claim submission and compliance with all relevant regulations. They will also provide excellent customer service, handle inquiries, and assist with denial management.

Responsibilities

• Submits accurate and timely claims to third party payers
• Resolves claim edits and account errors prior to claim submission
• Follows up with third party payers to ensure collections and departmental goals
• Gathers statistics, completes reports, and performs other duties as scheduled or requested
• Organizes and executes daily tasks in priority to achieve optimal productivity, accountability, and efficiency
• Complies with notices of privacy practices and follows HIPAA regulations
• Contacts third party payers to resolve unpaid claims
• Utilizes payer portals and 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 job and personal growth needs
• 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
• Maintains working knowledge of all federal, state, and local regulations pertaining to professional billing
• Monitors accounts to facilitate timely follow-up and payment to maximize cash receipts
• Maintains confidentiality according to policy when interacting with patients, physicians, families, co-workers, and the public regarding demographic/clinical/financial information
• Communicates problems hindering workflow to management in a timely manner

Requirements

High School diploma or equivalent. One (1) year medical billing/medical office experience preferred. Excellent oral and written communication skills. Working knowledge of computers. Knowledge of medical terminology preferred. Knowledge of business math preferred. Knowledge of ICD-10 and CPT coding processes preferred. Excellent customer service and telephone etiquette. Ability to use tact and diplomacy in dealing with others. Maintains knowledge of revenue cycle operations, third party reimbursement, and medical terminology including all aspects of payer relations, claims adjudication, contractual claims processing, credit balance resolution, and general reimbursement procedures. Ability to understand written and oral communication.

Qualifications

Minimum qualifications include a high school diploma or equivalent. No specific certifications or licenses are required.

Skills

• Excellent oral and written communication skills
• Working knowledge of computers
• Knowledge of medical terminology preferred
• Knowledge of business math preferred
• Knowledge of ICD-10 and CPT coding processes preferred
• Excellent customer service and telephone etiquette
• Ability to use tact and diplomacy in dealing with others
• Maintains knowledge of revenue cycle operations, third party reimbursement, and medical terminology including all aspects of payer relations, claims adjudication, contractual claims processing, credit balance resolution, and general reimbursement procedures
• Ability to understand written and oral communication

Benefits

No specific benefits are mentioned in the job posting.

Pay

No specific pay information is provided in the job posting.

Schedule

No specific schedule information is provided in the job posting.