Medical Claims Insurance Specialist - Remote

Possess a thorough working knowledge of the revenue cycle management process. Responsible for the research and resolution of aging account receivables to that are either unpaid or incorrectly paid. Demonstrate the company’s core values of respect, honesty, integrity, diversity, inclusion, and safety.

• Analyze, audit and resolve claims outstanding, denied, or incorrectly paid
• Review and respond to payer correspondence.
• Submit appeals as needed for denied claims.
• Contact insurance companies and navigate payer websites in order to secure and expedite insurance payments.
• Resolves patient billing inquiries.
• Document in detail all actions taken in accounts receivable system.
• Meet productivity expectations as outlined by supervisor.
• Recognize, document and notify Team Lead of trends resulting in nonpayment or incorrectly paid claims.
• Answer and resolve inbound calls from insurance carriers.
• Participate in process improvement initiatives as needed.
• Keep current with Medicare and other third party administrators regulations and procedures.
• Manage any special projects requested by supervisor or team lead.
• Must be able to perform the essential functions of this position with or without reasonable accommodation.

Minimum Position Qualifications:

• High school diploma

• 1+ year of insurance follow-up including working knowledge of the appeals resolution process
• Strong written, and oral communication skills
• Analytical and problem solving capabilities with close attention to detail.
• Excellent organizational and follow-up skills
• Thorough working knowledge of revenue cycle management including medical terminology,ICD-9, ICD-10, CPT-4 coding, Medicare reimbursement guidelines, billing and collection practices
• Ability to read and interpret EOB's
• Highly self-motivated, with ability to work independently and meet deadlines
• Ability to remain flexible during times of change and adjusts promptly and effectively
• Must be able to learn, understand, and apply new technologies

Originally posted on Himalayas