Claims Specialist

5 days ago


Silver Spring, Maryland, United States Community Clinic Inc. Full time
Job Summary

Community Clinic Inc. is seeking a skilled Claims Specialist to join our team. As a key member of our healthcare operations team, you will play a critical role in ensuring the timely and accurate processing of medical claims.

Key Responsibilities
  • Review and analyze medical encounters to ensure completeness and accuracy, adhering to all relevant regulations and guidelines.
  • Process claims in a timely manner, adhering to a standard of claim submission within five days from the date of service.
  • Address any claims that are rejected by the clearinghouse or payer, resolving and resubmitting with corrections.
  • Communicate with health centers and support center personnel to effectively challenge denials and reverse the denial decision.
  • File appeals of denials in a timely and professional manner, adhering to specified timeframes.
  • Respond to patient, insurance, and professional inquiries and concerns in a timely and professional manner.
  • Maintain current understanding and application of all Medicare and state Medicaid compliance requirements.
  • Communicate with third-party payers to achieve expeditious claim adjudication and payment.
  • Maintain accurate and up-to-date records of account balances and payment status.
  • Evaluate patient financial status and establish budget payment plans or eligibility for Sliding Scale consideration.
Requirements
  • Minimum High School diploma, an AA or BS degree preferred or commensurate experience.
  • At least 2 years of relevant work experience in a Physician Practice/Hospital-based Physician Center/FQHC setting or equivalent combination of training and experience.
  • Strong attention to detail and analytical skills.
  • Familiarity with hospital and physician coding.
  • Strong customer service skills, with bi-lingual (English/Spanish) a plus.
  • Assertive and goal-oriented with a willingness to participate in ongoing educational activities.
  • Familiarity with computerized systems and a willingness to learn new technologies.
Why Work at Community Clinic Inc.?
  • Extensive benefits plan, including generous PTO and 403B Retirement Plan with employer match.
  • Tuition Reimbursement and Continuing education assistance.
  • Opportunity to work in a diverse and inclusive workplace grounded in community.
  • Chance to improve health equity through the provision of affordable primary care for all.

Community Clinic Inc. is an Equal Opportunity Employer.


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