Medical Claims Clearinghouse Specialist

POSITION SUMMARY

Responsible for the accurate entry of physician and ancillary charges into Claims Clearinghouse module.

RESPONSIBILITIES AND ACCOUNTABILITIES

• Submits provider claims to clearinghouse on a daily basis.
  • Correct claims errors for clean claim submission on day of submission.
    • Communicate to Supervisors and other team members to assist in claim error correction.
    • Document the number of claims received and rejected on the daily claim’s submission log
    • Correspond to Supervisors to improve workflows to prevent claim errors.
    • Create reports with Supervisor to track trends within the Clearinghouse.
    • Keeps up on changes in medical billing and coding
    • Afford assistance with special accounts receivable projects
• Customer Service and Communications:
  • Communicates with patients, insurance carriers and other outside entities in a professional manner.
  • Identifies solutions and responds professionally to patient concerns, i.e., pleasant tone of voice, courteous language, etc.
  • Uses appropriate grammar and demonstrates tact and diplomacy in patient interactions, by phone and in person.
  • Diffuses negative situations with patients and maintains a pleasant and professional tone during stressful circumstances and heavy workload.
  • Communicates with staff members in a professional, pleasant manner.
  • Shares information relevant to work, no gossiping or disparaging remarks, accepts work without complaint or provides reasons why assignment is unmanageable, asks and answers questions related to improving department performance.
• TEAMWORK
  • Willingly provides coverage, volunteers assistance, and maintains workflows within department as needed without direct instruction/supervision.
  • Works cooperatively and refrains from participating in negative conversations.
  • Shares knowledge and insights with co-workers in a constructive manner.
  • Works to solve problems and address conflicts with appropriate person directly before involving leadership or uninvolved peers.
  • Is considerate of others in the work environment with regard to taking breaks or meal periods, use of computer and phone, noise level in the department, etc.

POLICIES AND PROCEDURE

• Policies and Procedures
  • Knows and complies with policies and procedures as enumerated in the Orthopedic One Employee Handbook and policies and procedures documents.
  • Provides assistance and support to leadership in implementing policies and procedures as necessary.
  • Actively participates in training, and conducting day to day work activity by adhering to all policies and procedures as enumerated in compliance and risk management programs.

QUALIFICATIONS

• Education, Experience, Certification and Licensure Requirements:
  • A high school diploma/GED required.
  • A minimum of five years of previous medical billing experience preferred.
  • Ideal candidate will have experience in managing claims through clearinghouse.