Insurance Claims Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee patient account balances, ensuring precise claim submissions, adherence to regulations, prompt follow-ups, and assistance with denial management.

• Deliver customer support and address issues arising from inquiries made by customers.

• Accurately submit claims to third-party payers in a timely manner.

• Resolve claim edits and account discrepancies prior to claim submission.

• Follow up with third-party payers to guarantee collections and surpass departmental objectives.

• Collect statistics, complete reports, and undertake clerical tasks.

• Reach out to third-party payers to address unpaid claims.

• Utilize payer portals and websites to confirm claim statuses and perform account follow-ups.

• Assist Patient Access and Care Management in investigating and resolving denials.

• Research and handle mail returns and claims rejected by payers.

• Reconcile billing account transactions and execute billing and follow-up activities.

• Stay informed about federal, state, and local hospital billing regulations.

• Monitor accounts to ensure timely follow-ups and payments, maximizing cash receipts.

• Maintain work queue volumes and productivity in accordance with established guidelines.

• Provide outstanding customer service to patients, visitors, and staff.

• Attend departmental meetings, teleconferences, and webcasts as required.

• Engage in performance improvement initiatives.

• Collaborate with supervisors and managers to set and exceed annual goals.

• Uphold confidentiality regarding demographic, clinical, and financial information.

• Communicate workflow issues to management promptly.

⛳️ Requirements

• High School diploma or equivalent qualification.

• Preferred one (1) year of experience in medical billing or a medical office setting.

• Exceptional oral and written communication abilities.

• Proficient working knowledge of computers.

• Excellent customer service skills and telephone etiquette.

• Capability to engage with tact and diplomacy when interacting with others.

• Preferred knowledge of medical terminology.

• Preferred understanding of business math.

• Preferred familiarity with ICD-10 and CPT coding processes.

• Knowledge of revenue cycle operations, third-party reimbursement, payer relations, claims adjudication, contractual claims processing, credit balance resolution, and general reimbursement procedures is preferred.

• Ability to comprehend written and oral communication effectively.

• Must be able to remain seated for extended periods.

• Reading and comprehension abilities are essential.

• Visual acuity must be within normal limits.

• Must possess effective communication skills.

• Must have manual dexterity to operate keyboards, fax machines, telephones, and other office equipment.

🏝️ Benefits

• Full-time schedule of 40 hours per week.

• Opportunities to participate in educational programs for mandatory requirements, career advancement, and personal development.

• Reasonable accommodations may be provided for individuals with disabilities.