We are looking for a motivated performer to join our team as a In-Network Claims Specialist, with an extensive knowledge of claims reimbursement and collection.

We are looking for a top performer with an extensive knowledge of billing, collections, and reimbursement of claims processing. This is a fast-paced environment committed to producing the highest quality work.

JOB SUMMARY

• Under the direction of the Director, the Collections Specialist is responsible for follow up on current and delinquent center claims, working an expected number of claims per day. Majority of claims will have been submitted to various insurance carriers electronically. Knowledge of how to interpret In-Network Insurance contract and Workers Compensation claims is a must.
• Ability to appeal denied and deficient claims
• You will be given tools to calculate allowable and required to determine the appropriateness of reimbursement and appeal claims as necessary.
• Experience with billing and collections with Behavior Health.
• Extensive contact with insurance carriers of all types
• Ability to read & understand an EOB
• Participates in educational activities and reports needed information to the Director.
• Identification of accounts that have been either under or overpaid, issuing credit balance information to the insurance carrier.
• All of these practices done in a professional and communicative manner, per policies and procedures, guidelines, internal control measures and established goals.
• Candidate must be a team player and have the ability to communicate well with direct reports, and insurance carriers.
• Ability to manage accounts worked independently, and in a productive manner.
• Must project a professional demeanor and appearance while maintaining the confidentiality of the surgery center and patients.
• Works well in the stressful environment and in situations that demand patience.
• Projects a professional demeanor and appearance while maintaining the confidentiality of administration, patients, physicians, and employees.
• Works under stress and in situations that demand patience and tact while providing impeccable service.

SKILLS

• Aggressive follow up in collecting from insurance companies
• Skill in fast data entry and accuracy.
• High level of discretional, interpersonal skills.
• Tactfulness in dealing with patients, co-workers other professional offices.
• Knowledge of medical terminology
• Interact with external/internal customers as necessary to resolve problems and expedite payments
• Obtain status of outstanding claims
• Problem Solving/Troubleshooting
• Follow-up on outstanding AR balances assigned by management.
• Ensure timely and accurate processing of re-bills to the appropriate insurance companies
• Provide detailed information regarding problem payors to management
• Submit appeals based on denials from
• Provide suggestions for solutions to management

BENEFITS

• Our competitive salary and benefits package includes medical, vision, and dental insurance, 401(k), paid time off and life insurance.

TECHNICAL REQUIREMENTS:

• Typing 45-60 WPM.
• High School Diploma or equivalency.
• Proficient in Microsoft Office products.
• Experience with Electronic Patient Information Systems.
• Minimum of Medical Collections Experience
• Knowledge of CPT, and/or ICD-10
• Knowledge of legal and regulatory government provisions
• Knowledge of laws that regulates communication and privacy act. HIPAA laws and understanding of the application of all above
• Prefer previous experience with Electronic Health Record system but will train.

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