| Department: | RCM | Supervises: | Sub-Department: | Corporate Support Center | Reports To: | Billing Specialist | Date Completed: | 06/06/2025

General Position Description: Ensure claim accuracy and high-quality customer service through review, correction, and resubmission of rejected and delinquent claims within timely filing limits.

Core Responsibilities:

Review all assigned Practice Management claim errors, determine the appropriate action, correct and file all claims with error status

Review all assigned Clearinghouse claim errors, determine the appropriate action, correct and file all claims with error status and note actions in patients’ chart

Review all assigned insurance payor rejections, determine the appropriate action, correct and re-file all rejected claims Review and maintain the Clearinghouse workgroup list, ensure the resubmission process is complete

Ensure that all claims within assigned receivables meet timely filing requirements

Assist management in identifying trends in rejection results with various insurance carriers

Maintain current knowledge of assigned insurance carrier’s rules and regulations both federal and commercial

Ensure that month-end goals are met in a timely manner

Work with clinic supervisors and staff to improve the capture and accuracy of demographic information as well as other information critical to claim processing and reimbursement

Observe safety and security procedures; promote a safe and pleasant work environment

Regular attendance to ensure efficient operations

Assist in questions from other departments concerning rejections

Other duties and responsibilities:

Other duties and responsibilities as assigned.

Qualifications:

High school graduate or equivalent.

Proven ability to work in a team environment.

Articulate communication skills and excellent customer service skills.

Computer knowledge, e.g., Microsoft Office. Accuracy and detail orientation with high level of productivity.

Familiarity with ICD-10, and CPT coding, as well as experience reviewing and understanding insurance EOBs is preferred.

Physical Demands/Work Conditions:

Office environment. Sitting and keyboarding for extended periods of time.

High attention to detail and ability to focus. Moderate noise level.