Claims Processing Specialist

Description

OVERALL RESPONSIBILITIES:

• Performs all duties in a timely fashion with attention to established time filing limits for insurances assigned.
• Demonstrates in depth knowledge of billing guidelines and requirements for insurances
• Verifies all customer information and authorizations needed for compliant billing process
• Verifies correct data entry of live orders including inventory items, quantities, multipliers, and special pricing specific to insurance
• Verifies correct data entry of Referral/Authorization, verifies and logs pars
• Verifies required documentation prior to confirmation
• Verifies authorization is obtained when required
• Verifies modifiers and cert notes are entered correctly as well as specs on equipment
• Verifies proof of delivery prior to confirmation
• Understands requirements for billing, order editing, insurance qualifications
• Utilizes a/r computer reports to prioritize follow up for reimbursement on denied claims For insurances
• Follows the implemented collection procedures on all accounts for insurances assigned
• Document in the computer system's claim management case notes to show how claim was worked
• Submit Processing Issues to manager on denied claims needing further action.
• Submit write offs to CFO
• Prepare account reviews for requesting parties in timely manner.
• Review with manager any problems/trends that are hindering the collection process.
• Complete adjustments per policy and for rebilling.
• Suggest improvements to the billing and collection processes to reduce denials and increase efficiency.
• Complete a/r analysis on denials when necessary as an education toll for other departments.
• Perform other duties or projects as objectives are established and approved by management.

Qualifications

MINIMUM QUALIFICATIONS:

Must be detail and goal oriented, organized, possess strong written and verbal communication skills, strong interpersonal skills, display time management skills and the ability to juggle and prioritize workload, and work well with others. Computer skills required. Background in healthcare-related industry and knowledge of medical third party billing preferred. Knowledge of Microsoft Word and Excel helpful.