Healthcare Claims Specialist

7 days ago


Little Rock, United States Wollborg Michelson Recruiting Full time
Job DescriptionJob Description

We’re searching for Claims Specialists for our Arkansas area

Details:

  • Fully Remote
  • 3 month contract with possibility of extension/hire
  • Pay: $18-$22 hourly
  • Monday-Friday 8am-5PM CST
  • MUST be able to work in CST time
  • Medical claims processing experience – AMISYS strongly preferred
  • This role may involve phone work such communicating with providers and members when processing claims.

Summary

The Claims Specialist resolves medical claims that are not automatically adjudicated by the claims processing system in a timely and accurate manner according to divisional standards of quality and productivity. Resolution may include additional investigation or communication in order to obtain necessary information to complete the claim.

Responsibilities

  • Claims processing involves the actions required to pay or deny pended claims (those which did not auto-adjudicate), including entering data into the system; reviewing and interpreting contract benefits; conducting edit and audit resolution; determining benefit eligibility.
  • Identifying and researching processing issues through systems and manuals; routing claims to other areas; consulting internal staff and medical providers; generating correspondence; and completing forms to obtain necessary information.
  • Demonstrating knowledge of and possessing the ability to access all relevant computer systems and screens in order to process claims accurately; staying current with continually changing processing procedures, benefits, and system modifications; being knowledgeable of and able to meet corporate and national (MTM) standards while maintaining acceptable performance levels based on established departmental standards for productivity and quality; and showing familiarity with corporate and professional manuals and guidebooks, including the company processing manual and ICD, CPT, and HCPS codebooks.

Requirements:

  • Review and process insurance claims submitted by healthcare providers, which could include hospitals, doctors, laboratories, and other medical facilities.
  • The Claim Specialist will ensure that claims are accurate, complete, and compliant with insurance policies and regulatory guidelines.
  • Verify the accuracy of information provided in the claim, such as patient details, medical services provided, diagnosis codes, and billing codes.
  • Adjudicating claims by determining whether they meet the criteria for coverage as outlined in the policy.
  • Analyze supporting documents, such as medical records, treatment plans, and invoices, to ensure that the services billed match the services rendered and that they are medically necessary.
  • Participate in quality assurance initiatives to ensure that claims are processed accurately and efficiently, minimizing errors, and maximizing customer satisfaction.

Minimum Job Requirements

  • High School diploma or equivalent.
  • Two (2) years of college coursework (48 semester hours) or other equivalent certification with an emphasis in anatomy, medical terminology, math, biology, or a related field
  • One (1) year of related office experience such as claims processing, health insurance, or medical office.

If you're interested in learning more Apply today

Wollborg Michelson Recruiting does require all applicants to be able to provide proof that they are fully vaccinated from COVID prior to their start date, unless otherwise prohibited by law. Wollborg Michelson Recruiting is an Equal Opportunity Employer and prohibits discrimination of any kind. We ensure job offers are made based of one’s employment experience, skills, and qualifications, regardless of race, gender, ethnic origin, or any other classification protected by law. All applicants must furnish proper identification to prove their legal right to work in the US upon a job offer. We participate in E-Verify to confirm one’s right to work in the US. Wollborg Michelson Recruiting does not provide sponsorship for an employment-based visa status.



  • Little Rock, United States Wollborg Michelson Recruiting Full time

    Job Description Job Description We’re searching for Claims Specialists for our Arkansas area! Details: Fully Remote 3 month contract with possibility of extension/hire Pay: $18-$22 hourly Monday-Friday 8am-5PM CST MUST be able to work in CST time Medical claims processing experience – AMISYS strongly preferred This role may involve phone work such...


  • Little Rock, United States CareerBuilder Full time

    Job Description Job Description Were searching for Claims Specialists for our Arkansas area! Details: Fully Remote 3 month contract with possibility of extension/hire Pay: $18-$22 hourly Monday-Friday 8am-5PM CST MUST be able to work in CST time Medical claims processing experience AMISYS strongly preferred This role may involve phone work such communicating...

  • Audiologist or Hearing Aid Specialist Wanted

    Found in: beBee jobs US - 7 days ago


    Little Rock, Arkansas, United States Hearing Healthcare Recruiters Full time

    HEARING HEALTHCARE RECRUITERS is proud to present this opportunity in the beautiful state of South CarolinaWe are seeking an Audiologist or Hearing Aid Specialist in the Little River, SC area wh

  • Billing Specialist

    2 weeks ago


    Little Rock, United States Arkana Laboratories Full time

    Job DescriptionJob DescriptionWho we are: At Arkana Laboratories, everyone has an important role to fill. Come join us and be a part of a team dedicated to making life better for those who need it most.This place is packed with super-smart people who do their best work together. We work hard every day to advance our understanding of disease and provide...

  • Billing Specialist

    1 day ago


    Little Rock, United States Arkana Laboratories Full time

    Job DescriptionJob DescriptionWho we are: At Arkana Laboratories, everyone has an important role to fill. Come join us and be a part of a team dedicated to making life better for those who need it most.This place is packed with super-smart people who do their best work together. We work hard every day to advance our understanding of disease and provide...


  • Little Rock, United States Alleviant Health Centers Full time

    Job DescriptionJob DescriptionAlleviant Integrated Mental Health is the largest full-service, multi-site outpatient psychiatry practice in Arkansas. In fact, we will see more than 70,000 Arkansans this year. We have become the primary referral source for many major systems in the state. We see all new patients within five days of connecting with them and...


  • Little Rock, Arkansas, United States Hearing Healthcare Recruiters Full time

    HEARING HEALTHCARE RECRUITERS is proud to present this opportunity in the beautiful state of ArkansasWe are seeking an Audiologist or a Hearing Aid Specialist in the Little Rock, AR area who is

  • Utilization Specialist

    Found in: Lensa US P 2 C2 - 3 days ago


    Little Rock, United States Independent Case Management Full time

    And Duties Community Supports: Obtain and utilize working knowledge and maintain accountability for program standards in respective catchment areas listed below and others as they become applicable: PASSE systems HCBS DDS DCFS Maintains day to day wo Behavioral Health, Specialist, Billing Specialist, Support, Healthcare, Budget, Program


  • Little Rock, United States CARTI Full time

    DescriptionJOB SUMMARY: The Pre-Certification Specialist II (Chemotherapy) provides specialized assistance to our patients and clinical staff using their knowledge base of pre-certification requirements of insurance plans as well as provide excellent patient service. SPECIFIC JOB DUTIES AND RESPONSIBILITES: Verify all demographic and insurance information...

  • Patient Experience Specialist

    Found in: Talent US C2 - 1 week ago


    Little Rock, United States University of Arkansas for Medical Sciences Full time

    Summary of Job Duties :The Patient Experience Specialist is a highly trained professional who helps resolve systematic challenges that impact the healthcare experience. The Patient Experience Specialist consults with departments, staff, managers to identify overall experience of care goals and barriers or concerns which may interfere with targeted goals,...

  • Referral Specialist

    Found in: beBee jobs US - 2 weeks ago


    Little Rock, Arkansas, United States Hollister, Inc. Full time

    ABC Home Medical Supply, Inc is one of the nation's leading urological supply providers and serves as a one-stop shop with a comprehensive line of medical supplies and service that includes: Urological, Incontinence, Wound Care, and Ostomy. ABC Medical is part of the JDS, Inc family of businesses. Our service companies possess the knowledge and expertise to...

  • Credit Specialist

    7 days ago


    Little Rock, United States Uniek Full time

    The Credit Specialist will perform a variety of accounting tasks for Accounts Receivable, General Accounting and Credit Review. They will assist in the application of accepted accounting procedures to maintain accounting records and files. Must be highly organized with strong attention to detail, comfortable with multi-tasking, have strong interpersonal...

  • Payment Processing Specialist

    Found in: Talent US C2 - 2 weeks ago


    Little Rock, United States Arkansas Heart Hospital Full time

    Position Summary : This position is responsible for the electronic and manual posting of insurance and patient payments. Interprets insurance explanation of benefits (EOBs) and adjusts patient accounts accordingly. This position requires knowledge of medical charges and allowed amounts by insurance carriers and the ability to enter data with high...

  • Account Specialist

    Found in: Talent US C2 - 7 days ago


    Little Rock, United States Genuine Parts Company Full time

    SUMMARY: The Account Specialist drives sales, identifies, and generates opportunities for various types of customers. This role partners with Account Representatives within an assigned territory to deliver deep knowledge within a product group. The Account Specialist provides education of Motion products through technical presentations. JOB DUTIES: ...


  • Little Rock, United States Arkana Laboratories Full time

    Job DescriptionJob DescriptionWho we are: At Arkana Laboratories, everyone has an important role to fill. Come join us and be a part of a team dedicated to making life better for those who need it most.This place is packed with super-smart people who do their best work together. We work hard every day to advance our understanding of disease and provide...

  • Pathology Solutions Specialist

    Found in: beBee jobs US - 1 day ago


    Little Rock, Arkansas, United States Roche Full time

    Roche fosters diversity, equity and inclusion, representing the communities we serve. When dealing with healthcare on a global scale, diversity is an essential ingredient to success. We believe that inclusion is key to understanding people's varied healthcare needs. Together, we embrace individuality and share a passion for exceptional care. Join Roche,...


  • Little Rock, United States Disability Solutions Full time

    Roche fosters diversity, equity and inclusion, representing the communities we serve. When dealing with healthcare on a global scale, diversity is an essential ingredient to success. We believe that inclusion is key to understanding people's varied healthcare needs. Together, we embrace individuality and share a passion for exceptional care. Join Roche,...

  • Health System Specialist- GHATP

    Found in: beBee jobs US - 7 days ago


    Little Rock, Arkansas, United States Department Of Veterans Affairs Full time

    Summary This position serves as a Graduate Healthcare Administrative Training Program (GHATP) Trainee functioning as a Health System Specialist in the Office of the Director of the Medical Facility and is responsible for managing projects and assisting in the coordination of daily office activities. The position is responsible for all program matters under...

  • Account Specialist-Hose

    Found in: Talent US C2 - 7 days ago


    Little Rock, United States Genuine Parts Company Full time

    SUMMARY: The Account Specialist-Hose role sells directly to customers with a technical focus on hose products. This role focuses on developing and implementing sales strategies, identifying potential customers, and managing existing customer relationships specifically for hose products. JOB DUTIES: • Assesses customer needs and suggests appropriate...


  • Little Rock, United States SCA Pharmaceuticals, LLC Full time

    Job DescriptionJob DescriptionDescription:SCA Pharmaceuticals is a dynamic rapidly growing company consisting of passionate individuals who believe in our mission of providing high quality medications that are critical in saving and sustaining human life. SCA Pharma is an FDA 503B outsourcing facility providing customized medications for hospitals and...