Claims Specialist

7 days ago


Battle Creek, Michigan, United States Grace Health Full time
Job Title: Claims Specialist

We are seeking a highly skilled Claims Specialist to join our team at Grace Health. As a Claims Specialist, you will play a critical role in ensuring the accuracy and efficiency of our claims processing operations.

Key Responsibilities:
  • Review and analyze medical claims for accuracy and completeness
  • Enter charges into our Practice Management System
  • Handle correspondence related to patient accounts and answer billing-related questions
  • Produce claims on a regular schedule to Medicare, Medicaid, and other third-party payers
  • Stay up-to-date with insurance regulations and make recommendations for accounts to be written off or turned over for collection
Requirements:
  • High school diploma or equivalent
  • Entry-level experience in coding and/or claims processing in a healthcare organization
  • CPC or similar credentials preferred

At Grace Health, we offer a competitive salary, up to 3 weeks of PTO in the first year, and a comprehensive benefits package, including medical, vision, dental, life, and disability insurance, 401K match, and 8 paid holidays. We also offer an employee wellness program focusing on physical, mental, and financial wellness.

BASIC JOB PURPOSE: To review and analyze medical claims for accuracy and completeness, enter charges into our Practice Management System, handle correspondence related to patient accounts, and answer billing-related questions.

EXAMPLES OF DUTIES: (This list may not be all inclusive.)

  1. Enters charges into Practice Management system submitted from Dental provider (EDR pending charges, or encounter form & off-site charge forms).
  2. Acquires patient billing information from patients and source documents.
  3. Produce claims on regular schedule to Medicare, Medicaid, insurance carriers, and other third-party payers to ensure prompt payment.
  4. Keeps abreast of the various insurance regulations.
  5. Makes recommendations concerning accounts to be written off or turned over for collection.
  6. Enters all actions related to patient's account into Practice Management System as permanent record.
  7. Assists patients with application process for schedule of discounts program.
  8. Facilitates prior authorization for dental procedures.
  9. Manages Senior Millage Program, tracking and reporting.
  10. Works dental tasks submitted by third-party billing company (RCM).
  11. Participates in professional development activities.

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