Insurance Claims Specialist – PB

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.

• Aid in denial management to enhance hospital revenue cycle operations.

• Deliver customer support and resolve issues stemming from customer inquiries.

• Submit claims to third-party payers accurately and on time.

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

• Follow up with third-party payers to assist collections and meet departmental objectives.

• Collect statistics, prepare reports, and carry out clerical tasks.

• Organize and prioritize daily responsibilities to maximize productivity and efficiency.

• Comply with HIPAA regulations and Notices of Privacy Practices related to PHI and claims.

• Contact payers to address outstanding claims.

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

• Support Patient Access and Care Management in denial investigations and resolutions.

• Participate in department meetings, teleconferences, and webcasts.

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

• Reconcile billing account transactions and execute billing and follow-up activities.

• Maintain up-to-date knowledge of federal, state, and local professional billing regulations.

• Monitor accounts to ensure timely payments and optimize cash receipts.

• Manage work queue volumes and productivity within established parameters.

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

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

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

• Report workflow challenges to management.

⛳️ Requirements

• High School diploma or equivalent.

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

• Strong oral and written communication skills.

• Proficient knowledge of computer operations.

• Exceptional customer service skills and telephone etiquette.

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

• Capability to comprehend written and verbal communication.

• Familiarity with medical terminology is preferred.

• Understanding of business mathematics is preferred.

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

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

• Must be able to remain seated for extended durations.

• Must possess reading and comprehension skills.

• Visual acuity must fall within the normal range.

• Must be able to communicate effectively.

• Must have manual dexterity for operating keyboards, fax machines, telephones, and other office equipment.

• Must be eligible to work in the United States of America.

🏝️ Benefits

• Full-time work schedule.

• 40 hours scheduled each week.

• Involvement in educational programs for mandatory requirements, career advancement, and personal development.

• Initiatives aimed at performance improvement.

• Reasonable accommodations available for individuals with disabilities.