Provider Claim Specialist

· Verify insurance eligibility and benefits for patients.

· Electronic claims submission and paper claim submission.

· Reviews and analyzes denials to determine best course of action based on the denial and remark codes.

· Work insurance correspondence, remittance advice, submits corrected claim and/or appeals in efforts to resolve denial and collect payment.

· Exam corrected claim to ensure proper billing determined by LCD or payer guidelines.

· Identify and communicate trends, issues with insurance denials and billing edits.

· Respond to patient account inquires and provide billing statements, payment receipts, itemized statement and billing records as requested.

· Performs billing audits to ensure all services were properly captured by RCM.

· Reviews coding denials to provide resolution/suggestions to coders based on LCD or payor guidelines.

· Payment posting of ERA and paper EOPs.

· Download and import ERA files form clearinghouses or payor direct web portal.

· Review and resolve underpayments and or refunds request.

· Performs insurance collection calls.

· Communicates effectively with other departments to resolve billing, claims or credentialing issues.

· Proactively manage and follow-up on accounts receivables (AR) aged greater than 45 days and maintains all RCM Work-queues.

· Analyze reporting and analytics to reduce AR by contacting payers and escalating issues to resolve unpaid / underpaid claims.

· Stay current on payer requirements and other pertinent industry knowledge via research to ensure guidelines and procedures are being met for each payer.

· Performs projects and additional daily reports.

· Performs other duties as assigned.

Job Type: Full-time

Pay: $19.82 - $30.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift

Experience:

• Payment posting of ERA and paper EOPs: 2 years (Required)

Ability to Commute:

• Miami, FL 33199 (Required)

Work Location: In person

Salary : $20 - $30