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Claims Resolution Specialist
2 months ago
Insurance Billing & Follow-Up Specialist
Facility: Catholic Health Services
Department: Billing and Claims Management
Category: Administrative Support
Schedule: Full Time
Shift: Day Shift
Hours: 8 AM - 4 PM
Position Overview: Under the supervision of the Physician Revenue Realization Manager, the Insurance Billing & Follow-Up Specialist plays a crucial role in managing the claims process with insurance providers, ensuring timely resolution of denied claims within the EPIC billing system.
Key Responsibilities:
- Conduct follow-ups on all assigned outstanding accounts, adhering to established protocols and standards.
- Identify reasons for claim denials and initiate appeals as necessary.
- Review and amend any rejections resulting from electronic billing submissions, ensuring claims are corrected and resubmitted promptly.
- Verify the accuracy of patient insurance details and demographic information.
- Generate invoices for services that are not covered by insurance.
- Investigate instances of overpayments and take appropriate measures to resolve these issues, including initiating refund requests in line with departmental procedures.
- Respond to inquiries from patients, insurance companies, and external agencies in a professional and courteous manner.
- Submit secondary claims to the relevant payors.
Qualifications:
- High School diploma or equivalent is required.
- A minimum of 3 years of experience in Physician Billing, including insurance follow-up and customer service, is essential.
- Strong understanding of medical insurance processes and healthcare billing practices.
- Proficient in accounts receivable systems and related applications.
- Excellent communication skills to effectively interact with insurance carriers, patients, and colleagues.
- Ability to adhere to procedural guidelines and seek assistance when faced with atypical situations.
At Catholic Health Services, we prioritize your well-being, offering a comprehensive range of compensation and benefits that extend beyond the basics. Our offerings include multiple medical plans, life insurance, generous paid time off, flexible spending accounts, substantial tuition reimbursement, an employer-funded pension plan, and various savings plan options for your future.
