Claims Specialist

The Claims Specialist is responsible for following up directly with commercial and governmental payers to resolve billing issues and secure appropriate reimbursement in a timely manner. This individual identifies and analyzes denials and payment variances and enacts corrective measures as needed to effectively communicate and resolve payer errors.

Responsibilities

Examines denied and underpaid claims to determine reasons for discrepancies; Communicates directly with payers to follow up on outstanding claims, resolve payment variances, and achieve timely reimbursement; Works with management to identify, trend, and address root causes of denials; helps pinpoint strategies for reducing A/R; Maintains a thorough understanding of federal and state regulations, as well as specific payer requirements and explanations of benefits, to identify and report billing compliance issues and payer discrepancies; Effectively handles all communications, including telephone and email, from payers and departments with the business office; Participates in continuous quality improvement efforts on an ongoing basis, establishing goals with supervisors and tracking progress; Demonstrates initiative and resourcefulness by making recommendations and communicating trends and issues to management; Understand and maintains compliance with HIPAA guidelines when handling patient information; Performs other duties as assigned; Promotes a team atmosphere by treating individuals with respect and honesty and by using direct communication and active listening skills.

Requirements

High school diploma or equivalent required; Minimum of one year of relevant experience in mental health or medical insurance billing and/or collections required; Demonstrated knowledge of and experience with third-party payer guidelines, reimbursement, follow-up, and collections; Demonstrated knowledge of claims review and analysis; ICD-10, CPT, and HCPCS coding; and medical terminology; Effective communication, leadership, organizational, and problem-solving skills; Ability to manage multiple tasks and projects simultaneously; Ability to analyze data, identify improvement, and implement change; Strong interpersonal and customer service skills; Proficiency with Microsoft Word, Excel, Outlook, Teams, OneNote and Oracle Health Patient Accounting systems; Ability to work quickly and effectively in a fast-paced detail-oriented environment while adhering to deadlines.

Benefits

Health, dental, and vision insurance coverage for you and your family; 401(k) retirement plan; Employee share program; Life/disability insurance; Flex spending accounts; Tuition reimbursement; Health and wellness program; Employee assistance program (EAP)