Claims Specialist

Park Dental•Roseville, MN

6d•$22 - $25•Remote

About The Position

Responsible for providing support to doctors, practices, and Revenue Cycle teams with high-level insurance claim issue resolution. This role involves proactively working open insurance claims to ensure prompt processing, managing aging reports to verify unpaid claims are in process with payers, and improving claim flow by identifying and resolving claim handling issues with the Insurance Specialist. The Claims Specialist will interpret payer explanation of benefits to ensure claims are adjudicated according to contract guidelines, appeal and follow up on denied claims, and resolve electronic claim rejections and resubmit corrected claims. Personal and Professional Responsibilities include effectively communicating and building strong working relationships with doctors and team members, fostering teamwork, trust, open communication, creative thinking, and collaboration. The role also requires assuming responsibility for personal professional growth through training and continuing education, and adhering to Park Dental policies, professional expectations, and Service Excellence Standards. The Claims Specialist will serve as an example of the organization's Mission, Vision, and Values.

Requirements

Practice Management, dental EDI experience and knowledge
Claims and/or dental familiarity
Proven systems aptitude and strong MS Office skills (Excel, Access and Word)
Familiarity with insurance company website
A quick study of new systems and software tools and a willingness to embrace technology to improve productivity
Possess strong communication skills and the ability to develop constructive and cooperative working relationships with others, striving for collaboration and demonstrating professionalism
High skill level of interpreting a variety of payers’ explanation of benefits
Understands coordination of benefits guidelines in depth
Ability to manage multiple activities simultaneously with minimal direction, while relying on experience and judgment to plan and accomplish goals
Detail oriented and well-organized
Self-motivated and the ability to work independently
Able to effectively deal with multiple locations, variety of internal customers, and patient situations
Minimum two-year associates degree, bachelor’s degree preferred
Familiarity with Dental and Medical insurance claims
Experience with verbal and written communication to healthcare professionals and patients

Responsibilities

Proactively work open insurance claims to ensure prompt processing
Work aging report to ensure unpaid claims have been received and are in process with payers
Improve claim flow by working with Insurance Specialist to proactively identify and resolve claim handling issues
Read and interpret payer explanation of benefits to verify claims adjudicated in accordance with contract guidelines
Appeal and follow up on denied insurance claims as assigned
Review, identify, and resolve payer denials
Provide payers’ requested additional information to allow claim processing
Resolve electronic claim rejections
In practice management system, correct and resubmit claims stopped by our clearinghouse
Correct and resubmit claims rejected by payer clearinghouse
Effectively communicate and develop a strong working relationship with the Doctors and all Team Members and promote teamwork through cooperative and professional behaviors
Create an environment which promotes trust, open communication, creative thinking, and team collaboration
Assume responsibility for personal professional growth through internal and external training opportunities and continuing education offerings
Follow and demonstrate commitment to the Park Dental policies, professional expectations, and Service Excellence Standards
Serve as an example and representative of the organization by demonstrating behaviors consistent with Park Dental and The Dental Specialists Mission, Vision, and Values