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Claims Processing Specialist
2 months ago
NOTE: Experience within the Behavioral Health Industry is required. This is a fully remote position.
Role Summary:
The primary focus of this role is to manage the billing of institutional and professional claims to various insurance providers. The specialist will be responsible for auditing and conducting thorough research to ensure compliance with payer billing guidelines for the submission of clean claims. This position will involve overseeing the billing functions for multiple facilities as designated.
Key Responsibilities:
- Timely submission of accurate claims according to the billing schedule set by management.
- Provide support for other facilities as required.
- Ensure adherence to specific billing guidelines and communicate any necessary updates to management.
- Reconcile charges within the patient accounting system to guarantee that all billable charges are captured and submitted promptly.
- Manage rebill requests and assist with various billing projects as assigned.
- Review and rectify billing edits in Waystar to facilitate claim submission.
- Participate in month-end closing activities.
- Maintain knowledge of all managed care organizations (MCO).
- Commit to personal professional growth and development.
- Contribute to facility-wide performance improvement initiatives.
- Perform additional duties as assigned.
Qualifications:
Education:
- A high school diploma or an equivalent combination of education, experience, and training that provides the necessary knowledge, skills, and abilities is required.
Experience:
- Prior experience in the Behavioral Health industry is mandatory.
- A minimum of five (5) years in a Business Office setting is preferred, with at least two (2) years in healthcare office management.
- At least one (1) year of experience in a billing environment, including exposure to verification, certification, authorization, managed care, revenue capture, and relationship management with payers.
Knowledge, Skills, and Abilities:
- Proficient understanding of medical terminology and the ability to accurately document payables, receivables, collections, and operational data.
- Exceptional oral and written communication skills in English; capable of performing routine numerical calculations for various reports; and able to exercise sound judgment and discretion in all interpersonal interactions.
