Claims Intake Specialist II - Part Time - Fully Remote!

SKYGEN•United States,

3d•$19 - $28•Remote

About The Position

The Claims Intake Specialist II ensures departmental tasks are completed to meet client turnaround times for claim payment and authorization determinations. The role manages special-handling requests and specialized workflows, supports data-entry processors, reviews reports and work queues, resolves issues, and communicates readiness to transfer data to other departments. It also serves as a subject matter resource for claims-intake matters and assists with training team members. This is a fully remote, part-time position scheduled Monday through Friday from 12:00 p.m. to 5:00 p.m. CST. Candidates must pass a pre-employment online alphanumeric data-entry assessment with a minimum score of 7,000 KSPH and 98% accuracy.

Requirements

High school diploma or equivalent.
At least 1 year of related experience, such as claim processing, dental assisting, dental front-office administration, health or dental insurance, managed care operations, accounts receivable, or billing.
Pass a pre-employment online alphanumeric data-entry assessment with a minimum score of 7,000 KSPH and 98% accuracy.
Ability to work effectively with multiple interruptions.
Ability to organize work to meet deadlines.
Excellent attention to detail.
Ability to multitask.
Ability to use resources to solve problems independently.
Excellent critical-thinking skills.
Excellent verbal and written communication skills.
Basic Microsoft applications skills.
Knowledge of insurance EOBs and billing codes.
Knowledge of American Dental Association (ADA) forms, UB-04 Facility Claim forms, or Member Reimbursement forms.

Nice To Haves

Bachelor’s degree in a related field.
At least 2 years of medical, dental, or vision claim-processing experience.

Responsibilities

Manage the daily work plan and distribute work to the team to meet client turnaround times.
Provide second-tier support and guidance to data-entry processors resolving submission discrepancies according to client business rules.
Manage specialized workflows for client requests that deviate from standard processes and coordinate resolutions with required departments.
Review reports, ensure work queues are completed, resolve open issues before claim payment and authorization review, and communicate readiness to transfer data to appropriate departments.
Proactively communicate potential issues to management for timely resolution.
Use multiple Enterprise System modules to retrieve and research information and process submission and special-handling requests.
Apply client processing guidelines and requirements.
Process primary insurance carriers’ EOBs for appropriate payment.
Serve as a subject matter expert for items sent to the Claims Intake team, answer internal and external questions, and resolve matters outside established workflows.
Identify provider submission errors and collaborate with internal teams on provider outreach and education.
Manage and process urgent operating room authorization requests submitted by fax and coordinate timely review and determination with the authorization team.
Resolve electronically submitted provider data discrepancies that prevent processing, using outside databases to validate provider credentials.
Assist with training internal team members.
Partner with the Claims Intake team on other tasks as needed to meet client service-level agreements accurately and on time.
Assist with special projects assigned by the leadership team.