Description
The Claims Specialist supports the areas of claims processing, denial management, and follow up. The individual in this role is primarily responsible for researching and solving denied Biologic claims, and reviewing and following up on unresolved claims, as well as submitting claims to the copay programs for Biologics.
Duties and Responsibilities:
•Review and research denied claims and make appropriate corrections
•Update insurance information with appropriate department as needed
•Track and follow up on denied claims
•Request information from insurance companies regarding claim denial
•Review submitted claims and aging claims and identify claims for reconsideration/appeal
•Review and submit insurance Appeals.
•Review and process medical records requests from insurance companies as needed
•Update Revenue Cycle Manager regarding denial trends
•Monitor claims payments for Copay programs.
•Other duties as assigned
Requirements

• High School Diploma.
• 2 years' experience preferred.
• Excellent verbal and written communication skills.
• Excellent organizational skills and attention to detail.
• Maintains professional friendly attitude.
• Excellent knowledge of payor policies and guidelines.
• Familiarity with coding guidelines.