Claims Processing Specialist

1 week ago

Geneva, New York, United States Finger Lakes Community Health Full time
Job Overview

Salary:

Finger Lakes Community Health utilizes BambooHR for the recruitment and onboarding of our personnel. All recruitment communications will originate directly from BambooHR and may be flagged as spam.

About Finger Lakes Community Health:

Established in 1989, Finger Lakes Community Health (FLCH) initially aimed to support the region's agricultural workforce by connecting individuals with local resources and delivering essential health services. In 2009, the organization broadened its scope to become a Federally Qualified Health Center (FQHC), catering to patients from diverse backgrounds and income levels. Over the past decade, FLCH has expanded its offerings to include medical, dental, and behavioral health services, currently serving over 28,000 patients across eight health centers. With a dedicated team of over 200 employees, we are committed to providing high-quality and innovative healthcare services throughout the Finger Lakes Region.

Position Summary:

The Claims Processing Specialist plays a crucial role in ensuring the precise and prompt handling of billing documentation. This position requires daily interaction with patients to address their billing inquiries. Medical billing can often be intricate and may lead to numerous questions from patients. As their advocate, you will be responsible for resolving any billing discrepancies that may arise between our office, the patient, and their insurance provider. The ideal candidate will maintain composure under pressure while assisting patients in challenging situations. Delivering exceptional customer service is essential for success in this role.

Key Responsibilities:

  • Collects necessary information and documentation to accurately and promptly submit medical/dental claims for eligible services provided by Finger Lakes Community Health, ensuring maximum allowable reimbursements.
  • Collaborates with the Health Center Site Coordinator to train and monitor the entry of accurate and timely data regarding patient insurance coverage and verification for services rendered.
  • Prepares, reviews, and submits error-free claims to all assigned insurance carriers for payment directly billed by Finger Lakes Community Health.
  • Reviews and posts insurance and third-party payments as they are received through the Explanation of Benefits or Electronic Remittance Advice.
  • Initiates follow-up on unpaid or denied claims promptly, taking necessary actions to secure claim payments.
  • Processes and posts credit card payments to the appropriate accounts received during phone interactions.
  • Reviews patient accounts for any calculation or charge/payment discrepancies as needed.
  • Promotes adherence to proper procedures by identifying claim errors and directing them to the appropriate personnel.
  • Assists in establishing payment arrangements with Health Center Site Coordinators for outstanding patient account balances.
  • Responds to billing inquiries from patients and staff as they arise.
  • Immediately informs the supervisor upon identifying any charges to a patient or insurance carrier that do not conform to standard practices.

Required Skills and Qualifications:

  • Knowledge of general accounting principles.
  • Basic computer proficiency.
  • Ability to adapt to various environments.
  • Strong prioritization skills.
  • Excellent organizational abilities.
  • Prior experience in Medical and Dental Billing is essential.
  • Coding experience is preferred.

Education and Experience:

  • High School Diploma or equivalent.
  • Valid New York State driver's license in accordance with FLCH drivers policy.
  • Current New York State automobile insurance compliant with FLCH underwriting standards.

Physical Requirements:

  • Ability to hear and communicate effectively with clients and staff via telephone and in-person interactions.
  • Capacity to lift up to 40 pounds.
  • Adequate vision to read memos, computer screens, registration forms, and other documents.
  • Manual dexterity to perform writing and keyboarding tasks.
  • Ability to reach above shoulder level, bend, squat, sit, stand, stoop, and kneel as required.
  • OSHA Level III compliance.

Finger Lakes Community Health utilizes BambooHR for the recruitment and onboarding of our personnel. All recruitment communications will originate directly from BambooHR and may be flagged as spam.

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