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.

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

• Follow up with third-party payers to ensure collections and surpass department objectives.

• Collect statistics, complete reports, and perform administrative tasks.

• Organize and execute daily responsibilities to enhance productivity, accountability, and efficiency.

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

• Contact third-party payers to address unpaid claims.

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

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

• Attend educational programs, departmental meetings, teleconferences, and webcasts.

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

• Reconcile billing account transactions and manage billing and follow-up processes.

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

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

• Maintain work queue volumes and productivity within set guidelines.

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

• Engage in performance improvement initiatives.

• Collaborate with the supervisor and manager to set and exceed annual goals.

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

• Promptly communicate workflow issues to management.

⛳️ Requirements

• High School diploma or equivalent qualification.

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

• Exceptional oral and written communication skills.

• Proficient knowledge of computers.

• Outstanding customer service skills and telephone etiquette.

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

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

• Ability to comprehend both written and verbal communication.

• Must be able to sit for prolonged periods.

• Must possess reading and comprehension skills.

• Visual acuity should be within the normal range.

• Must be capable of effective communication.

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

🏝️ Benefits

• 40 scheduled hours per week.

• Participation in educational programs for mandatory compliance, career advancement, and personal development.