Claims Research Specialist

SOUTHEASTERN RETINA ASSOCIATES PC • Knoxville, TN

13d • Onsite

About The Position

Assist with the revenue cycle management of SERA’s Billing Department with a primary focus on the resolution of error, rejected and delinquent claims. This includes, but is not limited to: reviewing claims, researching identified errors, compiling required documentation and preparing the appropriate correspondence to ensure payment.

Requirements

• Requires in depth understanding of medical reimbursement and coding, including Medicare and Third-Party Insurance guidelines, with the ability to apply knowledge to daily responsibilities.
• Thorough understanding of medical billing, collections and payment posting, revenue cycle, third party payers, Medicare; strong knowledge of TN, GA, VA and Federal payer regulations.
• Working knowledge of CPT and ICD10 codes, HCFA 1500, UB04 claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits and appeal processes.
• Knowledge of business management and basic accounting principles to promote effective communication between Billing and Accounting.
• Effective relationships with patients, physicians, staff and other people contacted in the course of the work.
• Proven records of attention to detail and commitment to accuracy in work performed including the ability to enter data accurately in end–user computer applications.
• High school graduate or GED Equivalent.
• Minimum 2 years’ experience in a medical billing office with knowledge of medical reimbursement and coding.

Responsibilities

• Maintain delinquent claims worklist queue and coordinate with fellow Claims Research Specialist.
• Review and research delinquent claims and take all necessary actions and/or corrections to ensure claims payment.
• Processing paper claims and electronically submitted claims including providing additional documentation as required by Carrier to ensure proper payment (Workman’s Compensation, skilled nursing facilities, etc.).
• Electronic data input of secondary claims for carriers requiring on-line claim submission.
• Answer incoming calls from patients, front desk staff and clinical staff as needed helping provide resolutions to current issues.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED