Insurance Claims Specialist

This is a fully remote position, open to applicants in Virginia, +1 more state.

📋 Description

• Oversee patient account balances through precise claim submissions, adherence to regulations, prompt follow-ups, and effective denial management.

• Ensure accurate and timely submission of claims to third-party payers.

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

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

• Reach out to payers to resolve outstanding claims.

• Utilize payer portals and websites to confirm claim statuses and perform account follow-ups.

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

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

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

• Reconcile transactions in billing accounts and manage billing and follow-up processes.

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

• Monitor accounts to ensure timely follow-up and optimize cash collections.

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

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

• Attend departmental meetings, teleconferences, and webcasts as required.

• Engage in performance improvement initiatives.

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

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

• Promptly communicate workflow issues to management.

⛳️ Requirements

• High School diploma or equivalent is required.

• Strong verbal and written communication skills.

• Proficient knowledge of computer systems.

• Exceptional customer service skills and telephone etiquette.

• Ability to exercise tact and diplomacy in interactions with others.

• Capability to comprehend written and spoken communication.

• Ability to remain seated for extended durations.

• Strong reading and comprehension skills.

• Normal visual acuity.

• Effective communication skills.

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

• Preferred knowledge of medical terminology.

• Preferred knowledge of business mathematics.

• Preferred knowledge of ICD-10 and CPT coding processes.

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

• Compliance with HIPAA regulations and Notices of Privacy Practices is mandatory.

• Must maintain confidentiality of demographic, clinical, and financial information.

🏝️ Benefits

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

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

• Reasonable accommodations may be provided for individuals with disabilities.