Claims and Denials Specialist
QUALIFICATIONS:
High school diploma is required. Three years of experience in data entry, demonstrated proficiency on a computer terminal is necessary. One year of billing experience for third party payers in a medical/mental health facility or physician office preferred. Capable of pertain a 10-key calculator. Working Knowledge of ICD-10 and CPT/HCPCS coding standards. Working Knowledge of health insurance and billing practices.
PHYSICAL DEMANDS:
Abilities in reaching, bending, talking, fingering, sitting, carrying, standing, grasping, fine hand coordination, ability to hear, ability to read and write, and the ability to remain calm under stress. Ability to reach with hands and arms, climb stairs, balance, stoop, kneel, crouch or crawl. Specific vision abilities include close, distance, color, peripheral, depth perception and the ability to adjust focus. Must be capable of lifting 50 pounds of dead weight alone. May be required to complete standing presentations involving speaking and listening to audience.
WORK ENVIRONMENT:
General office, health care setting. Most work completed while seated at desk using standard office equipment. Fast paced, team approach. Multi-tasking requiring above average time management skills. Team approach.
FUNCTIONAL RESPONSIBILITIES INCLUDE:
- Contacts insurance companies for payment requests, overdue payments, and denied claims.
- Reviews denials and issues for non-payment of services, thoroughly research reasons for denied claims as assigned to resolving outstanding balances and maintain timely follow up of outstanding claims/balances daily
- Identifying and correcting billing errors.
- Works Insurance Accounts Receivables Reports daily
- Produce reports to reduce age trial balances by contacting clients for collection or sending secondary claims.
- Provides customer service to clients educating them on balances due, billing procedures and coding issues.
- Assists with Billing as needed
COMPLIANCE RESPONSIBILITIES INCLUDE:
- Adheres to all applicable federal, state, local, and company maintained standards of compliance, ethics, and policies concerned with the administration and delivery of agency services.
- Meets deadlines, requirements, and expectations as established by the supervisor, agency and department.
- Completes administrative functions and data entry timely and accurately.
CUSTOMER SERVICE RESPONSIBILITIES INCLUDE:
- Provides exceptional customer service in all communications and interactions with staff, general public.
- Maintains confidentiality and remains calm under stress.
- Assists staff with support in all areas of functional responsibility in a courteous, supportive manner.
- Maintains and exhibits servant leadership qualities and exceeds customers' expectations.
FISCAL RESPONSIBILITIES INCLUDE:
- Effective, efficient use of agency resources, systems, equipment and processes.
- Continuous focus on cost savings initiatives across the responsibilities and deliverables.
- Effective use of time management to avoid overtime and budgetary issues.
