Insurance Claims Specialist

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

📋 Description

• Oversee patient account balances, which includes submitting claims, ensuring regulatory compliance, performing timely follow-ups, and managing denials.

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

• Address claim edits, account discrepancies, unpaid claims, rejected claims, and billing concerns.

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

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

• Collect statistics, prepare reports, and execute clerical tasks.

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

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

• Maintain work queue volumes and productivity according to established guidelines.

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

• Participate in departmental meetings, teleconferences, and webcasts as needed.

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

• Report workflow issues to management and collaborate with supervisors and managers to meet annual objectives.

⛳️ Requirements

• High School diploma or its equivalent.

• Strong oral and written communication abilities.

• Proficient in computer usage.

• Exceptional customer service skills and telephone etiquette.

• Capable of exercising tact and diplomacy in interactions.

• Ability to comprehend both written and verbal communication.

• Capacity to remain seated for extended periods.

• Proficient reading and comprehension skills.

• Visual acuity within a normal range.

• Effectively communicate with others.

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

• Familiarity with medical terminology is preferred.

• Understanding of business math is preferred.

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

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

• One year of experience in medical billing or a medical office setting is preferred.

🏝️ Benefits

• Engage in educational programs to fulfill mandatory requirements and address personal and professional development needs.

• Participate in performance improvement initiatives.

• Reasonable accommodations may be provided to enable individuals with disabilities to perform essential job functions.