Insurance Claims Specialist

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

📋 Description

• Submit precise and timely claims to third-party payers.

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

• Follow up with third-party payers to ensure collections and surpass departmental targets.

• Collect statistics, complete reports, and carry out scheduled or requested tasks.

• Organize and implement daily activities to enhance productivity, accountability, and efficiency.

• Adhere to Notices of Privacy Practices and HIPAA regulations regarding PHI and claim submission/follow-up.

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

• Utilize payer portals and websites to confirm claim status and conduct account follow-ups.

• Support Patient Access and Care Management with denial investigation and resolution.

• Engage in educational programs, department meetings, teleconferences, and webcasts.

• Investigate and process mail returns and claims rejected by payers.

• Reconcile billing account transactions and accurately process billing and follow-up transactions in a timely manner.

• Maintain a solid understanding of federal, state, and local hospital billing regulations.

• Monitor accounts to ensure timely follow-up and payment, thus maximizing cash receipts.

• Keep work queue volumes and productivity within established guidelines.

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

• Participate in initiatives aimed at performance improvement.

• Collaborate with supervisors and managers to develop and exceed annual objectives.

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

• Notify management promptly of any workflow issues.

⛳️ Requirements

• High School diploma or equivalent.

• Exceptional oral and written communication skills.

• Proficient knowledge of computers.

• Outstanding customer service and telephone etiquette.

• Ability to exercise tact and diplomacy when interacting with others.

• Preferred knowledge of medical terminology.

• Preferred knowledge of business mathematics.

• Familiarity with ICD-10 and CPT coding processes is preferred.

• Understanding of revenue cycle operations, third-party reimbursement, medical terminology, payer relations, claims adjudication, contractual claims processing, credit balance resolution, and general reimbursement procedures.

• Ability to comprehend written and oral communication.

• Must be capable of sitting for extended periods.

• Must possess reading and comprehension skills.

• Visual acuity should be within the normal range.

• Must be able to communicate effectively.

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

• One year of experience in medical billing or a medical office setting is preferred.

🏝️ Benefits

• Full-time schedule: 40 scheduled hours weekly.