Insurance Claims Specialist

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

📋 Description

• Oversee patient account balances by ensuring precise claim submissions, adhering to regulatory standards, conducting timely follow-ups, and managing denials.

• Accurately and promptly submit claims to third-party payers.

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

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

• Compile statistics, generate reports, and carry out clerical tasks.

• Prioritize daily responsibilities to enhance productivity, accountability, and efficiency.

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

• Contact payers to resolve outstanding claims and utilize payer portals to confirm claim statuses.

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

• Investigate and process returned mail and payer-rejected claims.

• Reconcile billing account transactions while ensuring accurate and timely processing of billing and follow-up transactions.

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

• Monitor accounts to ensure timely payments and optimize cash receipts.

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

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

• Engage in performance improvement initiatives, department meetings, teleconferences, and webcasts.

• Collaborate with supervisors and managers to formulate and surpass annual objectives.

• Uphold the confidentiality of demographic, clinical, and financial data.

• Report workflow issues to management in a timely fashion.

⛳️ Requirements

• High school diploma or equivalent is required.

• A minimum of one year of medical billing or medical office experience is preferred.

• Strong oral and written communication skills are essential.

• Proficient computer skills are necessary.

• Exceptional customer service skills and telephone etiquette are required.

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

• Capability to comprehend written and verbal communication effectively.

• Must be able to sit for prolonged periods.

• Proficient reading and comprehension skills are necessary.

• Visual acuity should be within normal limits.

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

• Familiarity with medical terminology is preferred.

• Knowledge of business mathematics is preferred.

• Understanding of ICD-10 and CPT coding processes is preferred.

• Working knowledge of revenue cycle operations, third-party reimbursement, payer relations, claims adjudication, contractual claims processing, credit balance resolution, and reimbursement procedures is essential.

• Effective communication skills are a must.

🏝️ Benefits

• Full-time position with 40 scheduled hours per week.

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

• Reasonable accommodations available for individuals with disabilities.