Claims Specialist

Scheduled Shift: Monday-Friday 8:00AM-5:00PM and other shifts as needed.

Job Summary

Responsible for collecting accounts receivables on patient accounts, non-government and contracted insurances government payers and secondary billing. Responsibilities include routine follow-up on accounts, working the Rejection Report for contracted insurances, analyzing aged trial balance report for assigned charge to's, working the Antrim, Rhodes reports and miscellaneous accounts receivable reports.

Essential Functions

• Collects outstanding accounts receivables on patient accounts from patient, commercial, non-government, contracted insurances or government payors via phone call to the patient or insurance company or by means of written appeal or reconsideration.
• Pursues collection activities on assigned accounts from primary and secondary payors until worked to resolution to include claims resubmission, appeal or reconsideration.
• Works account receivables reports (i.e. aged-trial-balance report), focusing attention on accounts over 60 days.
• Researches adjustments and pull all necessary backup to support adjustments.
• Utilizes on-line insurance resources to obtain and maintain current information.
• Develops and maintains a professional working rapport with internal and external customers to include contacts with insurance company representatives.
• Identifies trends in payment or non-payment of claims. Communicates findings to leadership and co-workers as appropriate.
• Customizes reports in Antrim and or Excel to prioritize accounts for collecting.
  
  

The above statements describe the general nature and level of work being performed by individuals assigned to this classification. This is not intended to be an exhaustive list of all responsibilities and duties required of personnel so classified.

Minimum Education

High school diploma or equivalent

Minimum Experience

Must have one of the following:

• Six (6) months as an Apprentice in the Business Office at TriCore
• Minimum of one (1) year of laboratory or medical claims follow-up/collections experience
• Minimum of three (3) years of medical billing or claims processing experience
  
  

Other Requirements

• Must be able to type 30 words per minute (typing test required)
• Must have basic PC knowledge and working expertise with keyboard, mouse, Internet, and Windows based applications
  
  

PREFERENCES: Basic knowledge of Excel and Word Knowledge of medical terminology

IMMUNIZATION REQUIREMENTS: Prove immunity to Hepatitis B or be immunized or sign a waiver refusing hepatitis immunization. Provide documentation of a PPD test conducted not more than 90 days prior to date of hire or have a PPD test conducted.

General Requirements

• Proficient in PC/data entry skills
• Must be able to work independently with little direction and to demonstrate sound judgment and problem solving skills
• Ability to resolve problems and follow up as needed or appropriate
• Effective communication skills and telephone skills
• Ability to deal with difficult clients and patients
• Strong working knowledge of insurance and reimbursement