Claims Processing Specialist II

Position Description: The Claims Processing Specialist is responsible for reviewing and processing all claims from the billing system and the clearinghouse. Responsible for working exception and rejection reports to ensure claims get cleared and processed to the payer in a timely manner.

Requirements

Responsibilities:

• Printing daily HCFA batches and ensuring all claims are mailed on a daily basis
• Attach necessary paperwork for secondary, school claims, and commercial claims as needed
• Basic knowledge of insurance and insurance payer guidelines
• Reviews & completes BLING Follow Up Dashboard for exceptions pertaining to subscriber, demographic, provider, and referring provider issues (BDOC, BDATA, BPINS, BREF)
• Works claims to clear edits, scrub for errors or rejections and ensure claims get processed to payer for payment
• Ensures accounts are processed and submitted to payers
• Identifies billing issues within Raintree Billing System and the clearinghouse; escalates as necessary and resolves issues to ensure clean claims are submitted
• Maintains a working knowledge of HIPAA, OSHA, Risk Management and compliance regulations
• Practices confidentiality in accordance with Company policies and all laws and regulations
• Attends Company meetings as required
• Other duties as assigned by RCO Management
  
  
  

Benefits

Qualifications:

• At least one year of Revenue Cycle experience required
• Knowledge and understanding of processes for varous payer groups and functions within the department
• Must demonstrate consistency in meeting productivity goals
• Proficient in Raintree Navigation
• Bachelor's degree preferred
• Basic computer proficiency is required
• Behaves in a manner consistent with Professional's mission, vision and values
• Ability to work independently and follow-through and handle multiple tasks and/or special projects simultaneously
  
  
  

Working Conditions:

• Works in an office/home environment
• He or she may spend long amounts of time sitting down
• May be required to walk up and down the stairs
• May be required to work evenings and/o weekends as job duites require