Senior 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.

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

• Address claim edits and account discrepancies prior to submission.

• Engage with payers to aid in collections and achieve departmental objectives.

• Contact payers to address unpaid claims and utilize payer portals to confirm claim statuses.

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

• Collect statistics, complete reports, and carry out clerical responsibilities.

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

• Monitor accounts to ensure timely payments and enhance cash collections.

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

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

• Uphold confidentiality and comply with HIPAA and privacy regulations.

• Act as a resource for colleagues regarding process queries and issues.

• Collaborate with the Hospital Billing Trainer to identify training opportunities for staff.

• Function as a Super User for Quadax, FISS, and various patient financial services software.

• Engage in performance improvement initiatives, departmental meetings, and policy evaluations.

⛳️ Requirements

• High school diploma or equivalent.

• Obtain CRCR certification through HFMA or Certified Revenue Cycle Specialist certification through AAHAM within 90 days of hiring.

• Three years of experience in medical billing or within a medical office.

• Complete eight hours of revenue cycle continuing education each year.

• Familiarity with third-party payers is essential.

• Proficient in computer usage.

• Strong oral and written communication skills.

• Exceptional customer service abilities and telephone etiquette.

• Competence in using the required computer software, applications, and office equipment.

• Capability to sit for prolonged periods.

• Strong reading and comprehension skills.

• Visual acuity within normal limits.

• Effective communication abilities.

• Preferred knowledge of medical terminology.

• Preferred understanding of business math.

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

• Up-to-date knowledge of third-party payer and managed-care billing requirements and contracts.

• Ability to maintain confidentiality regarding demographic, clinical, and financial information.

🏝️ Benefits

• Eight hours of revenue cycle continuing education required annually.

• Educational programs for mandatory requirements and recognized job and personal development needs.

• Scheduled weekly hours: 40.