Claims Processing Specialist
2 weeks ago
Position Summary:
The Claims Processing Specialist plays a crucial role in managing and resolving outstanding claims, ensuring timely reimbursement for services rendered. This position involves follow-up on claims, gathering necessary information, and performing essential billing tasks such as corrections, resubmissions, and appeals. The role is pivotal in meeting departmental productivity targets and ensuring effective claim resolution.
The initial responsibility of a Claims Processing Specialist is to engage with insurance providers and claims adjusters to confirm the status of overdue claims, particularly those aged over 45 days. This is primarily achieved through telephone communication and verification via Insurance Company Provider Portals. In cases of claim denial, the Specialist will procure the Explanation of Benefits from the Claims Adjuster and prepare the necessary documentation for appeals to secure reimbursement.
The Claims Processing Specialist will meticulously document all actions taken on patient claims within the billing software, assigning appropriate statuses and notes. Continuous monitoring of claims will be conducted until reimbursement is achieved or a determination is made regarding the claim's compensability.
Key Responsibilities:
- Direct communication with insurance companies to clarify their financial obligations related to client services.
- Accurate and timely documentation of all interactions in the patient’s billing account to facilitate prompt reimbursement.
- Follow-up on insurance claims that have been denied and manage the appeals process.
- Verification of eligibility and benefits through direct contact with insurance providers.
- Support additional billing and collection tasks as required.
- Conduct follow-ups with insurance carriers on claims that have not received responses to ascertain claim status and obtain necessary documentation.
- Utilize carrier portals to retrieve missing Explanations of Review (EOR) to assist in the appeals process.
- Review and respond to incoming correspondence from payors.
- Report any recurring issues or trends affecting billing accuracy and timeliness to management.
- Assist in compiling any missing or additional documentation required for claim resubmission.
- Engage in continuous quality improvement initiatives, setting goals with supervisors and tracking progress.
- Maintain strict confidentiality of Protected Health Information (PHI).
Qualifications:
- High School Diploma or equivalent; an Associate's Degree is preferred.
- 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 interpret various documents such as safety rules and procedure manuals.
- Proficient in writing routine reports and correspondence.
Key Competencies:
- Intensity
- Interpersonal Skills
- Effective Communication Skills (verbal and written)
- Active Listening Skills
- Problem Analysis and Problem-Solving
- Adaptability
- Initiative
- Stress Management
Compensation: Competitive hourly wage of $15-$18.
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