Billing Claims Specialist

Reliable Respiratory • Fairfield, CT

7h • Onsite

About The Position

The Billing Claims Specialist focuses on claims and procurement of authorizations and medical documentation to ensure Reliable is reimbursed in accordance with the procedures provided. This position reports to the Billing Manager, but will perform duties that pertain to customer service, documentation retrieval, medical billing and coding, and reimbursement. The primary purpose of this position is to identify reasons for claim denials and take all corrective action to resubmit the claim and obtain full reimbursement for the services rendered. Additional duties include: Review claims for denied procedures, identify issues, and take appropriate action to correct issue, resubmit claim, and procure maximum reimbursement for specific service. Duties include obtaining authorization, collecting medical documentation directly from facilities, and working with payers and provider services. Organize and report back denial trends to Management to implement measures to improve claim health and reduce payer AR times. Create and/or update written material and documentation related to insurance procedures and programs (i.e., insurance guidelines and processes and procedures). Assist in reviewing and analyzing relevant organizational and payer data (i.e., reviews payments and denials of insurance and communicates when changes need to be made for payment and profit margins) Develop and implement a system for working denials, ranging from dollar value to payor specialization, to age of invoice Issue invoices and bills and send them to customers through various channels (mail [https://resources.workable.com/mail-clerk-job-description], e-mail etc.) Receive payments through various methods (cash, online payments etc.) and check for credibility. Answer questions and handle complaints from customers and payors regarding claims Reconcile deposits and invoices posted.

Requirements

• 18 years of age or older
• Must be eligible to work in the United States and not require work authorization from us now or in the future
• Bachelor’s Degree required
• Strong health insurance knowledge of New England payers and Massachusetts ACO plans
• Proficient in obtaining authorizations in the most efficient manner (portal, fax form, phone in submission)
• Ability to learn Billing functions and be adaptable to the needs of the position.
• Strong interdepartmental communication
• Effective and professional verbal and written communication abilities
• Professional computer experience (especially Microsoft Office Suite)
• Ability to investigate problems and make decisions independently.
• Strong analytical skills
• Computer skills
• Interpersonal skills
• Product expertise
• Communication skills
• Results driven
• Conflict management
• Customer service
• Organizational skills

Nice To Haves

• At least 2 years of medical billing, coding, reimbursement or health insurance experience preferred

Responsibilities

• Review claims for denied procedures, identify issues, and take appropriate action to correct issue, resubmit claim, and procure maximum reimbursement for specific service. Duties include obtaining authorization, collecting medical documentation directly from facilities, and working with payers and provider services.
• Organize and report back denial trends to Management to implement measures to improve claim health and reduce payer AR times. Create and/or update written material and documentation related to insurance procedures and programs (i.e., insurance guidelines and processes and procedures).
• Assist in reviewing and analyzing relevant organizational and payer data (i.e., reviews payments and denials of insurance and communicates when changes need to be made for payment and profit margins)
• Develop and implement a system for working denials, ranging from dollar value to payor specialization, to age of invoice
• Issue invoices and bills and send them to customers through various channels (mail [https://resources.workable.com/mail-clerk-job-description], e-mail etc.)
• Receive payments through various methods (cash, online payments etc.) and check for credibility.
• Answer questions and handle complaints from customers and payors regarding claims
• Reconcile deposits and invoices posted.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Number of Employees: 101-250 employees