Job Summary

The Claim Specialist is responsible for assisting in collections by working with insurance companies and patients to resolve outstanding account balances, research and resolve account issues as needed, and to help our patients ensure their insurance coverage is being handled properly. Candidates will be working in a fast-paced environment where they will be expected to display strong customer service and attention to detail on either our Extended Business Office (Customer Service) or Insurance line. They will support patients by providing helpful information and answering questions. They will handle a moderate volume of incoming patient calls and a high volume of outgoing insurance calls. Alternatively, they will accurately review insurance accounts receivable for assigned clients for the purpose of identifying and taking the steps needed to ensure prompt claims adjudication, until claims are either paid or denied

Position Responsibility

• Multitasking between a variety of technology, systems, tools, and resources
• Providing empathetic and compassionate service that leaves a good impression
• Maintaining accurate notes of patient interactions in billing system
• Helping patients resolve balances, setting up payment arrangements, or helping them with financial assistance options when appropriate
• Review insurance accounts to determine the action steps needed to expedite claims payment and monitor claims until paid or denied
• Perform follow-up of action items to effect prompt account resolution; assign accounts to the disposition based upon status
• Document conversations with responsible parties regarding accounts in billing system
• Utilize automated claims verification systems via phone or online systems
• Professionally represent the Client when contacting external parties regarding the status of a claim
• Ability to review claims information and responses in a variety of formats including Explanation of Benefits, Remittances, ANSI standard, etc and learn common codes for payment and rejection.
• Ability to submit level one appeals to insurance companies for reconsideration.
• Meeting basic requirements for a variety of key performance indicators (goals)
• Understanding and complying with various company, state, and federal regulations

Qualifications

• Experience working with substance abuse centers is preferred
• At least 1 to 2 years of related work experience.
• Working knowledge of medical offices.
• Strong attention to detail.
• Degree preferred
• Must be able to complete and clear background check
• Strong Organizational skills
• Strong problem-solving skills
• Strong written and oral communication skills
• Time management and sound decision-making skills
• Deliver excellent customer service to both internal and external parties
• Perform basic mathematical calculations, balance, and reconcile figures
• Efficiently multi-task: shift priorities on short notice to respond to demands of work inventory changes

This is a 40 hour per week, full-time position.

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