Insurance Claims Specialist

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

📋 Description

• Oversee patient account balances, ensuring precise claim submissions and prompt follow-ups.

• Adhere to federal, state, and third-party billing regulations, as well as HIPAA requirements and Notices of Privacy Practices.

• Address claim edits, account discrepancies, unpaid claims, payer rejections, and returned mail.

• Reach out to third-party payers and utilize payer portals/websites to confirm claim statuses and perform account follow-ups.

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

• Submit claims to third-party payers accurately and within required timelines.

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

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

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

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

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

• Participate in department meetings, teleconferences, webcasts, and educational sessions.

• Cultivate and maintain knowledge of federal, state, and local professional billing regulations.

• Engage in performance improvement initiatives and collaborate with supervisors and managers to meet annual objectives.

• Report workflow issues to management while safeguarding the confidentiality of demographic, clinical, and financial information.

⛳️ Requirements

• High School diploma or equivalent required.

• Preferred: One (1) year of experience in medical billing or medical office settings.

• Exceptional oral and written communication skills.

• Proficient in computer usage.

• Strong customer service skills and professional telephone etiquette.

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

• Knowledge of medical terminology is preferred.

• Understanding of business math is preferred.

• Familiarity 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 procedures.

• Ability to comprehend written and oral communications.

• Must be able to sit for extended periods.

• Must possess reading and comprehension skills.

• Visual acuity must fall within the normal range.

• Effective communication skills are essential.

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

🏝️ Benefits

• Full-time schedule consisting of 40 hours per week.