Claims Management Specialist

UMC Health System•Richmond, KY

1d•Onsite

About The Position

UMC Health System is seeking a Claims Management Specialist. The ideal candidate must possess strong verbal and written communication skills, mainframe computer proficiency, basic accounting knowledge, detailed clerical skills, and excellent customer relations. This role requires managing accounts in adherence to third-party payer rules and regulations, along with a solid understanding of medical and third-party payer terminology. The position involves significant interaction with various UMC Health System departments, medical staff, technical personnel at Texas Tech University Health Sciences Center and Physician Network Services, and technical support analysts from contracted hardware and software vendors. UMC Health System is committed to equal employment opportunities and prohibits discrimination based on various protected characteristics. UMC is a Magnet Designated hospital with 501 licensed beds and 62 site locations, recognized as the region's only Level I Trauma Center and BICU, and is DNV accredited. It serves as the primary teaching hospital for the Texas Tech University Health Sciences Center (TTUHSC) and has been ranked as one of the Best Places to Work in Texas by Texas Monthly. UMC Physicians operates 35 practice locations, including private practices and urgent care centers, with over 125 physicians and advanced practice providers, also earning a "Best Places to Work in Texas" ranking and a 96% Employee Engagement Score.

Requirements

Ability to communicate both verbally and in writing
Mainframe computer skills
Basic accounting
Detailed clerical skills
Good customer relation skills
Ability to manage accounts according to third party payer rules and regulations
Understanding of medical and third party payer terminology
High school graduate or equivalent
Highly technical
Troubleshooting skills

Responsibilities

Process claim production queues appropriately
Review claim production reports and claim production edit reports
Understand payer specific requirements for electronic and paper claim submission
Document accurately on visits in IDX to convey the billing issue for correction.
Take corrective action when errors are noted on claims
Review payer confirmation reports to ensure all transmitted claims were received by payers
Review paper claims to ensure that affected claims cannot be submitted electronically
Work hold bills assigned by supervisor
Communicates effectively with supervisor and staff to reduce the number of recurring claim errors
Audits the payer table within Click-On to ensure that claims are submitted to the correct payers