Claims Specialist

4 weeks ago

Silver Spring, United States Community Clinic Full time
CCI Health Services' mission is to deliver high quality, accessible care to our community members, leading the way to a more equitable health care system for everyone.

Position Summary

CCI is seeking a Claims Specialist to serve as a financial resource in support of the clinical services provided. The Claims Specialist will assure that services are promptly and accurately processed in accordance with all applicable Federal, State, and local regulations and guidelines, that claims are adjudicated in a timely manner, and customer's needs are met in a professional and courteous manner.

Key Functions & Responsibilities
  • Review and analyze encounters to ensure completeness, accuracy, adherence to all system edits (both core system and clearinghouse), and in compliance with all State, Federal, and/or contracted payer rules, terms, regulations, and guidelines.
  • Ensures claims are processed in a timely manner, adhering to a standard of claim submission within five (5) days from the date of service, and follows up with individual and/or providers in those situations exceeding five (5) days from the date of service.
  • Ensures any claims which are rejected by the clearinghouse, or the payer are addressed, resolved, and resubmitted with corrections.
  • Addresses all denials from individual insurers in a timely, efficient, and collaborative manner, communicating with the health centers and support center personnel to effectively challenge denials and reverse the denial decision.
  • Files appeal of denials in a timely and professional manner within the specified timeframes as published by regulations, rules, or guidelines of the payer.
  • Responds in a timely and professional manner to all patient, insurance, or professional inquiries and concerns.
  • Exhibit and apply knowledge of Commercial Indemnity guidelines in the processing, adjudication, and payment of claims.
  • Maintain current understanding and application of all Medicare and state Medicaid compliance requirements regarding avoidance of allegations of fraudulent or false claims.
  • Maintain productive and efficient communication with third-party payers which achieves expeditious claim adjudication and payment.
  • Maintains consistent and timely follow-up with third-party payers and patients (as applicable) in unpaid claims beyond the expected payment date, ensuring each account is clearly and concisely documented with all efforts to expedite payment.
  • Utilize online claim status applications in an effective and efficient manner in managing account follow-up.
  • Make necessary adjustments to account balances with prior authorization from management to ensure the integrity of the account balance.
  • Checks each insurance payment to ensure accuracy and compliance with contract discount terms.
  • Evaluates patient financial status and established budget payment plans or eligibility for Sliding Scale consideration.
  • Must ensure open and constructive coordination with health center personnel in maintaining accuracy in data elements and processing crucial to effective claims processing and account resolution.
  • Must ensure adherence with all HIPAA Regulations and Compliance Regulations ensuring the protection of PHI (Patient Health Information).
Minimum Qualifications
  • Minimum High School diploma, an AA or BS degree preferred or commensurate experience.
  • Must have at least 2 years of relevant work experience in a Physician Practice/Hospital-based Physician Center/FQHC setting or can have an equivalent combination of training and experience to perform functions outlined for this position.
  • Strong attention to detail.
  • Must be familiar with hospital and or physician coding.
  • Strong customer service skills - bi-lingual (English/Spanish) is a plus.
  • Must be assertive and goal oriented.
  • Familiarity with computerized systems is required.
  • Must be a willing participant in ongoing educational activities and a contributing participant in staff meetings.
  • Working on-site is an essential duty for the job.

Why Work at CCI?
  • Extensive benefits plan
  • Generous PTO Plan
  • 403B Retirement Plan + Employer match up to 4%
  • Tuition Reimbursement
  • Continuing education assistance; can be used toward obtaining certifications, renewal of certifications, or possible conference attendance.
  • Our providers are insured for malpractice under the Federal Tort Claims Act.

** CCI Health Services is an Equal Opportunity Employer **

Founded in 1972, CCI Health Services is a diverse and inclusive workplace grounded in community. Located in the Washington, DC Metro Area, each year CCI cares for more than 60,000 individuals in Montgomery and Prince George's Counties. As a non-profit, CCI is committed to improving health equity through the provision of affordable primary care for all, across all stages of life. Visit ccicares.org for more information.

  • Claims Specialist

    2 days ago

    Silver Spring, United States CCI Health & Wellness Services Full time

    CCI Health Services’ mission is to deliver high quality, accessible care to our community members, leading the way to a more equitable health care system for everyone. Position Summary CCI is seeking a Claims Specialist to serve as a financial resource in support of the clinical services provided. The Claims Specialist will assure that services are...

  • Claims Specialist

    4 weeks ago

    Silver Spring, United States Community Clinic Inc. Full time

    Job DescriptionJob DescriptionCCI Health Services’ mission is to deliver high quality, accessible care to our community members, leading the way to a more equitable health care system for everyone.Position SummaryCCI is seeking a Claims Specialist to serve as a financial resource in support of the clinical services provided. The Claims Specialist will...

  • Claims Specialist

    6 days ago

    Silver Spring, United States Community Clinic Inc. Full time

    Job DescriptionJob DescriptionCCI Health Services’ mission is to deliver high quality, accessible care to our community members, leading the way to a more equitable health care system for everyone.Position SummaryCCI is seeking a Claims Specialist to serve as a financial resource in support of the clinical services provided. The Claims Specialist will...

  • Claims Support Specialist II

    3 weeks ago

    Silver Spring, United States Erie Insurance Group Full time

    **Claims Support Specialist II** **Location:** Silver Spring, MD, US, 20904 **Division or Field Office:** Silver Spring Branch Office **Department of Position:** Claims Department **Work from:** Silver Spring Branch Office At Erie Insurance, youre not just part of a Fortune 500 company; youre also a valued member of a diverse and inclusive team that...

  • Social Insurance Specialist

    1 month ago

    Silver Spring, United States USAJobs Full time

    DutiesThe position description number for this position is 5E2400. A summary of the major duties are listed below. You may also view the full position description on the Agency intranet at the following link: PD Search The incumbent serves as technical expert responsible for developing and adjudicating the most complex, non-routine Title II and/or Title XVI...

  • Social Insurance Specialist

    4 weeks ago

    Silver Spring, United States USAJobs Full time

    DutiesThe position description number for this position is 5E2400. A summary of the major duties are listed below. You may also view the full position description on the Agency intranet at the following link: PD Search The incumbent serves as technical expert responsible for developing and adjudicating the most complex, non-routine Title II and/or Title XVI...

  • Risk and Claims Specialist

    2 weeks ago

    Spring, United States Fcc Environmental Services Full time

    **Responsibilities**: - Collaborate with adjusters, agents, managers, and employees to acquire information that ensures accurate and comprehensive claims. - Manage and process all claims in a timely manner and act as an intermediary between the insurance companies and our company. - Create and update reports that display the outcomes of our successes and...

  • Social Insurance Specialist

    1 month ago

    Silver Spring, Maryland, United States USAJobs Full time

    DutiesThe position description number for this position is 5E2400. A summary of the major duties are listed below. You may also view the full position description on the Agency intranet at the following link: PD Search The incumbent serves as technical expert responsible for developing and adjudicating the most complex, non-routine Title II and/or Title XVI...

  • Social Insurance Specialist

    4 weeks ago

    Silver Spring, Maryland, United States USAJobs Full time

    DutiesThe position description number for this position is 5E2400. A summary of the major duties are listed below. You may also view the full position description on the Agency intranet at the following link: PD Search The incumbent serves as technical expert responsible for developing and adjudicating the most complex, non-routine Title II and/or Title XVI...

  • Accounts Payable Specialist

    1 month ago

    Silver Spring, United States Community Clinic Inc. Full time

    CCI Health Services' mission is to deliver high quality, accessible care to our community members, leading the way to a more equitable health care system for everyone. POSITION SUMMARY: The Accounts Payable Specialist handles the financial processing of transactions of CCI and oversees and participates in all accounting activities related to areas of...

  • Accounts Payable Specialist

    4 weeks ago

    Silver Spring, United States Community Clinic Inc. Full time

    CCI Health Services' mission is to deliver high quality, accessible care to our community members, leading the way to a more equitable health care system for everyone. POSITION SUMMARY: The Accounts Payable Specialist handles the financial processing of transactions of CCI and oversees and participates in all accounting activities related to areas of...

  • Regulatory Affairs Specialist

    2 weeks ago

    Silver Spring, Maryland, United States National Institutes of Health Full time

    Summary All candidates should make sure to read the following job description and information carefully before applying. The Research Regulatory Affairs-Facilities organization within ORSC provides regulatory support for the various cGMP and compounding facilities on campus. Support includes guidance in meeting the regulatory requirements with regards to...

  • Accounts Payable Specialist

    2 weeks ago

    Silver Spring, United States Community Clinic Inc. Full time

    Job DescriptionJob DescriptionCCI Health Services’ mission is to deliver high quality, accessible care to our community members, leading the way to a more equitable health care system for everyone.Position Summary:The Accounts Payable Specialist handles the financial processing of transactions of CCI and oversees and participates in all accounting...

  • Accounts Payable Specialist

    2 weeks ago

    Silver Spring, United States Community Clinic Inc. Full time

    Job DescriptionJob DescriptionCCI Health Services’ mission is to deliver high quality, accessible care to our community members, leading the way to a more equitable health care system for everyone.Position Summary:The Accounts Payable Specialist handles the financial processing of transactions of CCI and oversees and participates in all accounting...

  • Accounts Payable Specialist

    3 weeks ago

    Silver Spring, United States Community Clinic Inc. Full time

    Job DescriptionJob DescriptionCCI Health Services’ mission is to deliver high quality, accessible care to our community members, leading the way to a more equitable health care system for everyone.Position Summary:The Accounts Payable Specialist handles the financial processing of transactions of CCI and oversees and participates in all accounting...

  • Patient Scheduling Specialist

    2 weeks ago

    Silver Spring, United States CCI Health & Wellness Services Full time

    CCI Health Services is a 50-year-old Federally Qualified Health Center is a diverse and inclusive workplace that serves 60,000 medical patients and Women Infant's & Children (WIC) participants in Montgomery and Prince George's Counties. As a 501(c)3 non-profit, CCI is committed to providing high-quality, affordable primary healthcare to every patient across...

  • Accounts Payable Specialist

    1 month ago

    Silver Spring, United States Community Clinic Inc. Full time

    CCI Health Services’ mission is to deliver high quality, accessible care to our community members, leading the way to a more equitable health care system for everyone.POSITION SUMMARY:The Accounts Payable Specialist handles the financial processing of transactions of CCI and oversees and participates in all accounting activities related to areas of...

  • Accounts Payable Specialist

    4 weeks ago

    Silver Spring, United States Community Clinic Inc. Full time

    CCI Health Services’ mission is to deliver high quality, accessible care to our community members, leading the way to a more equitable health care system for everyone.POSITION SUMMARY:The Accounts Payable Specialist handles the financial processing of transactions of CCI and oversees and participates in all accounting activities related to areas of...

  • Proposal Specialist

    2 weeks ago

    Silver Spring, Maryland, United States Sedgwick Full time

    Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. Its an opportunity to do something meaningful, each and every day. Its having support for your...

  • Dental Insurance Specialist

    4 weeks ago

    Silver Spring, United States The Smile Suite Full time

    Duties: - Obtain insurance breakdowns and insurance data entry - Commuicating dental insurance benefits with patients - Patient treatment plan presentation and copay collection - Review and analyze records to ensure accurate claim submission - Collaborate with healthcare providers to clarify documentation and ensure proper claim submission - Provide...