Claims Research Specialist

2 days ago

Knoxville, Tennessee, United States SOUTHEASTERN RETINA ASSOCIATES PC Full time
Job Title: Claims Research Specialist

Job Summary:

We are seeking a highly skilled Claims Research Specialist to join our team at Southeastern Retina Associates PC. As a Claims Research Specialist, you will play a critical role in the revenue cycle management of our Billing Department, focusing on the resolution of error, rejected, and delinquent claims.

Key Responsibilities:

  1. Maintain a daily worklist in a timely manner, sharing the worklist queue with fellow Claims Research Specialists.
  2. Review and research delinquent claims, taking all necessary actions and/or corrections to ensure claims payment.
  3. Process paper claims, providing additional documentation as required by carriers to ensure proper payment.
  4. Enter electronic data for secondary claims for carriers requiring online claim submission.
  5. Answer incoming calls from patients, front desk staff, and clinical staff, providing assistance to resolve current issues.
  6. Process patient credit card payments over the phone.
  7. Perform other duties as assigned.

Requirements:

  1. Requires in-depth understanding of medical reimbursement and coding, including Medicare and Third Party Insurance guidelines.
  2. Ability to keep pace with a high volume of patients while performing multiple, sometimes complex tasks.
  3. Excellent interpersonal and communication skills to establish and maintain effective relationships with patients, physicians, staff, and other persons contacted in the course of work.
  4. Ability to work effectively with all levels of management and other colleagues, demonstrating initiative, mature judgment, and customer service orientation.
  5. Proven records of attention to detail and commitment to accuracy in work performed.

Education and Experience:

High School Diploma or GED Equivalent Required. Three years' experience in a medical office with knowledge of medical reimbursement and coding.

Work Environment:

The Physical Demands and Work Environment characteristics described below are critical features of this job, and are representative of those that must be met by an employee to successfully perform the essential functions.

TYPICAL PHYSICAL DEMANDS

Work may require sitting for long periods of time; also stooping, bending, and stretching for files and supplies. Occasionally lifting files or paper weighing up to 30 pounds.

Requires manual dexterity sufficient to operate a keyboard, operates a calculator, telephone, copier, and other office equipment as necessary. It is necessary to view and type on computer screens for long periods.

TYPICAL WORKING CONDITIONS

Work is performed in an office environment. Work involves frequent contact with staff members, physicians, and the public. Work may be stressful at times. Interaction with others is constant and interruptive. The noise level in the work environment is usually moderate. Occasional evening or weekend work as needed.

Reasonable Accommodation Statement:

Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions. The nature of those accommodations will be determined on a case-by-case basis.

HIPAA Requirements:

All employees are required to adhere to the SERA privacy practices as documented in the SERA Employee Handbook and all SERA HIPAA policies and procedures. Failure to comply may result in disciplinary action up to and including termination of employment.

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