What are the responsibilities and job description for the Claims Specialist position at Carolinas Center for Oral & Facial Surgery?
The Claims Specialist plays a vital role in our organization as the bridge between the insurance companies and our practices. The Claims Specialist supports the practice by reviewing and submitting patient charges to insurance companies to obtain reimbursement for services provided. As a detail-oriented professional, the Claims Specialist utilizes the documentation available to ensure all services are captured and coded with accuracy.
Essential Duties & Responsibilities
• Knowledge of both medical and dental insurances. • Knowledge of both medical and dental coding (CPT, CDT, ICD-10). • Review patient information to ensure all documentation and authorizations are obtained. • Ensure charges entered are coded correctly based on provided documentation. • Submit accurate claims adhering to insurance company guidelines. • Complete Ad Hoc claim worklists assigned by Revenue Cycle Leadership. • Support the philosophy, goals, and objectives of the Practice. • Adhere to safety policies and procedures in performing job duties and responsibilities. • Communicate effectively with co-workers, physicians, visitors, patients and other organizations. • Maintain and promote professional competence through continuing education and other learning experiences. • Report status of accounts daily to the Claims Supervisor. • Adept at prioritizing, planning work activities, and developing reasonable action plans. • Ability to work independently and collaboratively within a team environment. • Adhere to HIPAA Privacy and Security policies while performing job duties. • Actively participate in Revenue Cycle Team meetings, voicing successes, barriers, and process improvement opportunities. • Other duties as assigned.
Minimum Qualifications
• High school diploma or equivalent. • Knowledge of medical and dental insurances and coding. • Excellent verbal and written communication skills. • Excellent problem-solving skills. • Strong attention to detail and organizational skills. • Adaptable; readily adjusts work schedule to adhere to changes in the work environment and able to manage competing demands. • Proficiency in all Microsoft Office products.
Preferred Qualifications
• 2 years of experience with medical and dental insurance. • Associate's or bachelor's degree preferred. • Experience in a business office environment preferred.
