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Claims Account Specialist
2 months ago
Position Summary:
The Claims Account Specialist plays a crucial role in managing outstanding claims, ensuring all necessary information is collected, and executing essential billing tasks, including claim adjustments, resubmissions, and appeals. This position is vital in meeting departmental goals for productivity and claim resolution, as well as re-submitting claims when necessary. The Claims Account Specialist at Claimpay, Inc. specifically focuses on debts associated with Workman's Compensation patients who receive medication dispensed in-office.
Key Responsibilities:
- Engage directly with insurance providers to verify their financial obligations related to services rendered to our clients.
- Accurately document all communications in the patient’s account within the billing system to ensure prompt reimbursement.
- Conduct follow-ups on insurance claims that have been denied and manage the appeals process.
- Check eligibility and benefits with insurance companies through phone or online platforms.
- Assist with various billing and collection tasks as required.
- Follow up with insurance carriers and claims adjusters on billed claims that have not received responses (no payment or denial) to ascertain claim status and obtain the Explanation of Benefits.
- Utilize insurance portals to retrieve missing Explanations of Review (EOR) to support management in the appeals process.
- Review incoming correspondence from payors for necessary actions.
- Report any recurring errors or trends observed in billing or payor interactions that may hinder timely and accurate claims processing.
- Assist in gathering any missing or additional documentation required for claim resubmissions.
- Participate in ongoing quality improvement initiatives, regularly setting goals with supervisors and tracking progress.
- Maintain the confidentiality of Protected Health Information (PHI).
Qualifications:
- High School Diploma or equivalent; an Associate's Degree is preferred.
- A minimum of 2 years of experience in medical billing or collections is preferred.
- Familiarity with Explanations of Benefits (EOBs) and a solid understanding of copays, coinsurance, deductibles, and denial codes.
- Strong attention to detail with the ability to prioritize tasks independently.
- Capability to manage multiple tasks in a fast-paced office environment.
- Excellent customer service skills.
- Intermediate proficiency in MS Office applications.
- Knowledge of medical billing and collection practices.
- Ability to read and interpret various documents, including safety rules and operational instructions.
- Proficient in writing routine reports and correspondence.
Key Competencies:
- Intensity
- Interpersonal Skills
- Effective Communication Skills (verbal and written)
- Active Listening Skills
- Problem Analysis and Resolution
- Adaptability
- Initiative
- Stress Management
Compensation: $15-$18 Hourly Wage
