Health Claims Specialist
2 days ago
Description
• Responsible for all facets of insurance receivables of patient accounts • Follow-up of filed claims with insurers to ensure timely collection/acknowledgment of claims • Routinely works accounts receivables to recover unpaid account balances • Processes insurance payments, patient payments, and account adjustments when applicable • Research and resolve all rejections, denials, and claims monitoring items within clearinghouse platform • Process claims corrections, appeals, and secondary claim submissions following insurers requirements • Establishes and maintains effective working relationships with insurers provider representatives • Monitors and reconciles MCO claim activity; filing disputes and/or communicate issues with appropriate representative of managed care organization • Identification, tracking, and documentation of rejection, denial, and underpayment trends • Effective communication with patients and others to resolve account balance issues • Ensures detailed documentation to patient account regarding financial status and collections effort • Keeps current with industry knowledge • Maintains access to all insurance payer portals necessary to research eligibility, claims status, and claims payment • Mail sorting and cash receipts reconciliation in collaboration with accounting department • Scanning and distribution of all mail received for Revenue Cycle Department to appropriate parties • Masters all system computer functions applicable to duties and maintains proficiency • Provides guidance and assistance to coworkers in their absence or during peak times • Adheres to patient privacy policies and procedures, maintaining confidentiality at all times • Performs other duties or special projects as required or as assigned
Requirements
• High School Diploma or GED equivalent • 1-2 years of related work experience • Strong aptitude for math and accounting • Knowledge of medical terminology and understanding of NH Medicaid benefits programs • Basic knowledge of medical coding, billing rules, insurance reimbursement methods, and claims appeal process • Strong collaborating skills, and an ability to work effectively both independently and as part of a team • Comfortable in a fast-paced environment with frequent deadlines; high energy, self-motivated and proactive • Can organize and prioritize tasks to accomplish work • Knowledge of Microsoft Office products (Outlook, Word, Excel, Access, and PowerPoint)
Benefits
• Choice of 2 health insurance plans • Health Reimbursement Arrangement • Health Plan Opt Out Benefit • Health Savings Account • Flexible Spending Account • Dental Insurance • Vision Insurance • Group Life and AD&D Insurance • Short and Long Term Disability • Accident & Critical Illness Insurances • 403b Retirement Plan with Agency Match • Employee Assistance Plan • Generous Earned Time Off • Paid Extended Sick Time • 10 Paid Holidays • Bereavement Leave • Tuition Reimbursement • Supervision towards Clinical Licensure • Qualifying Employer for the Public Service Loan Forgiveness Program and NH State Loan Repayment Program
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