Claims Processing Specialist

2 weeks ago


Owings Mills, Maryland, United States Contracting East Mil Full time
Job Overview

The Claims Processing Specialist will conduct thorough analysis of claims submitted from the current billing system to the Clearinghouse. This role involves reviewing billing system tables and outbound claim files to identify issues that require attention and resolution.

Key Responsibilities

  • Oversees Clearinghouse administration tasks, including user additions and group creation. Completes necessary user administration control records.
  • Generates weekly reports summarizing achievements and outlines ongoing projects to present to management.
  • Analyzes rejected claims for trends at an enterprise level, ensuring familiarity with all aspects of the claims cycle.
  • Develops clear documentation of current processes and presents this documentation to management.
  • Provides training to users on Clearinghouse processes, demonstrating familiarity with these systems.
  • Monitors the lifecycle of claims and charges, identifying issues and notifying the appropriate management personnel.
  • Manages the claim ticketing process for Clearinghouse requests, reviewing and triaging tickets for claims research or other Clearinghouse functions.
  • Conducts claims audit processes, ensuring alignment between claim files and claim numbers sent from the billing system and received at the Clearinghouse, in preparation for internal audits.
  • Engages in training on Clearinghouse and billing systems available online to enhance functionality and obtain necessary certifications.
  • Participates in meetings regarding location implementation, new Clearinghouse reviews, and testing.
  • Assists with system claims testing and review.
  • Maintains consistent claims mapping information to ensure accurate electronic claims submission.
  • Ensures security, integrity, and business continuity controls are maintained and documented.
  • Delivers exceptional customer service to all practices, maintaining user confidence and safeguarding operational confidentiality.

Note: This is not an exhaustive list of all duties, responsibilities, and requirements of the position described above. Other functions may be assigned, and management retains the right to add or change duties at any time.

Minimum Qualifications, Education, and Experience

  • Ability to engage with customers and accurately document their needs.
  • Works collaboratively with all levels of management, communicating effectively.
  • Familiarity with claims processes and terminology, including Procedure codes, Diagnostic codes, and Modifiers.
  • Imaging Billing Experience is a plus.
  • Strong communication skills, demonstrating the ability to work with business units to resolve claims issues.
  • Minimum of two years of experience in the healthcare sector.
  • Proficient in Microsoft Office products such as Excel, Word, and Visio.
  • Knowledge of Microsoft Access is an advantage.

Quality Standards

  • Consistently communicates and collaborates professionally with all levels of supervision, co-workers, patients, visitors, and vendors.
  • Demonstrates initiative, self-awareness, professionalism, integrity, and maintains confidentiality in all performance areas.
  • Attends regular corporate meetings as required.
  • Adheres to OSHA regulations, company protocols, policies, and procedures.
  • Complies with HIPAA, privacy, safety, and confidentiality standards at all times.
  • Practices universal safety precautions.
  • Promotes positive public relations both over the phone and in person.
  • Adapts to and applies new tasks, methods, and systems as needed.
  • Reports to work as scheduled, maintaining punctuality and satisfactory attendance in accordance with company guidelines.
  • Completes job responsibilities in a timely and quality manner.


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