Insurance Claims Specialist

• Submit accurate and timely claims to third party payers
• Resolve claim edits and account errors before claim submission
• Follow up with third party payers to ensure collections and exceed department goals
• Gather statistics, complete reports, and perform scheduled or requested duties
• Organize and execute daily tasks to maximize productivity, accountability, and efficiency
• Comply with Notices of Privacy Practices and HIPAA regulations concerning PHI and claim submission/follow-up
• Contact third party payers to resolve unpaid claims
• Use payer portals and websites to verify claim status and conduct account follow-up
• Assist Patient Access and Care Management with denial investigation and resolution
• Participate in educational programs, department meetings, teleconferences, and webcasts
• Research and process mail returns and payer-rejected claims
• Reconcile billing account transactions and process billing and follow-up transactions accurately and timely
• Maintain working knowledge of federal, state, and local hospital billing regulations
• Monitor accounts to facilitate timely follow-up and payment and maximize cash receipts
• Maintain work queue volumes and productivity within established guidelines
• Provide customer service to patients, visitors, and employees
• Participate in performance improvement initiatives
• Work with supervisors and managers to develop and exceed annual goals
• Maintain confidentiality regarding demographic, clinical, and financial information
• Communicate workflow problems to management promptly

Requirements

• High School diploma or equivalent
• Excellent oral and written communication skills
• Working knowledge of computers
• Excellent customer service and telephone etiquette
• Ability to use tact and diplomacy in dealing with others
• Knowledge of medical terminology preferred
• Knowledge of business math preferred
• Knowledge of ICD-10 and CPT coding processes preferred
• Knowledge of revenue cycle operations, third party reimbursement, medical terminology, payer relations, claims adjudication, contractual claims processing, credit balance resolution, and general reimbursement procedures
• Ability to understand written and oral communication
• Must be able to sit for extended periods of time
• Must have reading and comprehension ability
• Visual acuity must be within normal range
• Must be able to communicate effectively
• Must have manual dexterity to operate keyboards, fax machines, telephones, and other business equipment
• One year of medical billing/medical office experience preferred

Core Competencies

Demonstrates expertise in medical billing processes, including claims submission, follow-up, and resolution, while ensuring compliance with HIPAA regulations. Proficient in utilizing payer portals and maintaining effective communication with third party payers to maximize collections and enhance customer service.

Highest-signal resume keywords

• Medical Billing Experience
• Claims Adjudication
• ICD-10 Coding Knowledge
• Customer Service Skills
• Revenue Cycle Operations

Hard Skills

• Claims Submission
• Claims Follow-Up
• Billing Reconciliation
• Medical Terminology
• Business Math
• CPT Coding
• Payer Relations
• Contractual Claims Processing
• Credit Balance Resolution
• Statistical Reporting

Soft Skills

• Excellent Communication Skills
• Tact and Diplomacy
• Organizational Skills
• Problem-Solving Skills
• Customer Service Etiquette

Industry Keywords

• HIPAA Compliance
• Third Party Reimbursement
• Revenue Cycle Management
• Healthcare Billing Regulations

Tools & Technologies

• Payer Portals
• Billing Software
• Office Equipment