Insurance Claims Specialist

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

📋 Description

• Submit claims to third-party payers accurately and promptly.

• Address claim edits and account discrepancies prior to submission.

• Engage with third-party payers to enhance collections and achieve departmental objectives.

• Compile statistics, complete reports, and fulfill scheduled or requested tasks.

• Organize and prioritize daily responsibilities to ensure productivity, accountability, and efficiency.

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

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

• Utilize payer portals and websites to check claim status and perform account follow-ups.

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

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

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

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

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

• Monitor accounts to support timely follow-up and maximize cash receipts.

• Maintain work queue volumes and productivity within set guidelines.

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

• Contribute to performance improvement initiatives.

• Collaborate with supervisors and managers to establish and surpass annual goals.

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

• Report workflow issues to management in a timely manner.

⛳️ Requirements

• High School diploma or equivalent is required.

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

• Strong oral and written communication skills are essential.

• Proficient working knowledge of computers.

• Exceptional customer service skills and telephone etiquette are required.

• Familiarity with medical terminology is preferred.

• Understanding of business math is preferable.

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

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

• Ability to comprehend written and spoken communication.

• Capability to sit for extended periods.

• Proficient reading and comprehension skills.

• Visual acuity within normal limits is necessary.

• Manual dexterity for operating keyboards, fax machines, telephones, and other office equipment is essential.

• Must possess effective communication skills.

🏝️ Benefits

• Full-time schedule of 40 hours per week.

• Access to educational programs for mandatory requirements and personal/job growth.

• Engagement in performance improvement initiatives.

• Reasonable accommodations for individuals with disabilities.