Claims Specialist I

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Requirements:

• Process-driven: Highly organized, operational thinker, rarely leaving questions unanswered.
• Adaptable: Comfortable in a fast-paced environment, with priorities changing weekly.
• Healthcare Experienced: Strong understanding of healthcare claims, plan benefits, and patient responsibilities. At least 2 years of experience in Medical Billing or Healthcare setting.
• Team Player: Collaborative by nature, relishes camaraderie and group wins, is looked to by colleagues or direct reports as a steadfast partner & source of encouragement.
• Tech-Savvy: Adept in chat, email, & phone communications.

Responsibilities:

• Research and find solutions to denied claims.
• Complete outbound calls to insurance carrier supervisors to investigate denial reasons.
• Resubmit claims with errors, utilizing knowledge of CMS 1500 forms and a broad understanding of data, coding, and policy errors.
• Draft appeals for relevant claim denials, adhering to medical policies for all insurance carriers.
• Ensure patient data in software is correct and most up-to-date, contacting the appropriate person for any inconsistencies.
• Prioritize workflows based on the age of claims.