Claims Processing Specialist

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.

Pay: $22.28 - $24.40

Hours: Monday-Friday 8:00 am - 4:30 pm

Responsibilities:

·        Works claims to clear edits, scrub for errors or rejections and ensure claims get processed to payer for payment.

·        Trains new hires on basics of daily work.

·        Reviews Raintree BLING Follow-Up Dashboard for first and second edit rejections (R-T, R-Z).

·        Reviews and contacts patients as needed for pre-claim eligiblity exceptions for inactive coverage or subscriber demographic issues.

·        Monitors claims processing emails and responds in a timely manner.

·        Performs claim correction tickets as needed.

·        Easily navigates  through Raintree to ensure claim edits are cleared and claims are submitted to payers.

·        Monitors No Response from Clearinghouse exceptions and ensures all claims are received an on file with payer.

·        Completes billing review and posts splint charges to ledger.

·        Successfully enters charges onto the DOL and Claim Connect Portals.

·        Stays abreast of laws and regulationsaffecting reimbursement.

·        Knowledge of insurance and insurance payer guidelines.

·        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.

·        At least three years of  Revenue Cycle experience required.

·        Knowledge and understanding of processes for varous payer groups and functions within the department.

·        Must demonstrate consistency in exceeding productivity goals.

·        Fully proficient in Raintree Navigation.

·        Able to demonstrate extensive knowledge using applicable tools/software applications and can identify trends/issues as needed.

·        Fully cross trained to work other functions in the department.

·        Bachelor’s degree preferred

·        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.

Salary : $22 - $24