Insurance Claims Specialist

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

📋 Description

• Oversee patient account balances, ensuring accurate claim submissions, compliance with regulations, timely follow-ups, and managing denials.

• Offer customer support and address issues that arise from inquiries made by customers.

• Complete necessary reports and perform clerical tasks as required.

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

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

• Follow up with third-party payers to aid collections and meet departmental objectives.

• Collect statistics and prepare reports.

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

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

• Contact third-party payers to resolve outstanding claims.

• Utilize payer portals and websites to verify claim statuses and conduct account follow-ups.

• Support Patient Access and Care Management with denial investigations and resolutions.

• Participate in educational programs, departmental meetings, teleconferences, and webcasts as needed.

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

• Reconcile billing account transactions and ensure billing/follow-up transactions are processed accurately and in a timely manner.

• Stay updated on 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.

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

• Engage in performance improvement initiatives.

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

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

• Report workflow issues to management promptly.

⛳️ Requirements

• High School diploma or equivalent qualification.

• One (1) year of experience in medical billing or a medical office setting (preferred).

• Exceptional oral and written communication abilities.

• Proficient in computer usage.

• Strong customer service skills and telephone etiquette.

• Ability to handle situations with tact and diplomacy.

• Familiarity with medical terminology (preferred).

• Understanding of business mathematics (preferred).

• Knowledge of ICD-10 and CPT coding processes (preferred).

• Insight into revenue cycle operations, third-party reimbursements, payer relationships, claims adjudication, contractual claims processing, credit balance resolutions, and general reimbursement protocols.

• Capability to comprehend both written and oral communications.

• Must be able to sit for prolonged periods.

• Possess reading and comprehension skills.

• Visual acuity must be within a normal range.

• Must be able to communicate effectively.

• Manual dexterity to operate keyboards, fax machines, telephones, and other business equipment is required.

🏝️ Benefits

• Participation in educational programs to fulfill mandatory requirements and address identified needs related to job and personal development.

• Reasonable accommodations may be provided to enable individuals with disabilities to perform essential functions.