Claims Specialist- Journal Center

Tricore Reference Laboratories • Albuquerque, NM

130d

About The Position

The Claims Specialist is 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, and working the Antrim, Rhodes reports and miscellaneous accounts receivable reports.

Requirements

• High school diploma or equivalent.
• 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, or Minimum of three (3) years of medical billing or claims processing experience.
• 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.

Nice To Haves

• Basic knowledge of Excel and Word.
• Knowledge of medical terminology.

Responsibilities

• 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 pulls all necessary backup to support adjustments.
• Utilizes online 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 and communicates findings to leadership and co-workers as appropriate.
• Customizes reports in Antrim and/or Excel to prioritize accounts for collecting.

What This Job Offers

• Industry: Ambulatory Health Care Services
• Education Level: High school or GED