Claims Specialist - Holista - Remote 1st shift!

Holista • Cullowhee, NC

7h • Remote

About The Position

The Claims Specialist will research and resolve all claims and authorization exceptions using internal resources. This role involves providing communication to providers regarding claim or authorization status and following up on financial implications of reprocessed claims or authorizations.

Requirements

• High school diploma or equivalent
• 1+ year(s) of general administrative or office experience.
• Proficient in MS Office Word/Excel/Outlook.
• Demonstrated Analytical and critical thinking skills.
• Ability to prioritize and organize multiple tasks.
• Ability to remain organized with multiple interruptions.
• Ability to successfully communicate with clients.

Nice To Haves

• Post secondary education in a related field.
• 3+ year(s) working with medical insurance/claim process.
• Previous experience working in a remote environment.
• Knowledge of health care and/or PT, OT, ST terminology, coding, and operations.

Responsibilities

• Transport all claims entered by processors from image software to proprietary software for review.
• Utilize knowledge of the system to research current queues of work to find claims requiring further research and correction.
• Research and resolve any claim and authorization issues to determine the best resolution.
• Work with internal departments to resolve issues involving authorization or claim handling.
• Recoup any overpayments to providers resulting from changes to a claim or authorization processing by posting to the provider account.
• Log all claims and authorizations that cannot be resolved and send rejection letters to providers.
• Using knowledge of authorizations, hold certain payments pending the outcome of client review.
• Adjudicate claims and send for payments ensuring that all proper documentation is attached.
• Complete daily audit of claims entered by Claim Intake representative.
• Take incoming calls from providers or members regarding authorizations, benefits, or claim status.
• Provide back up to Accounts Receivable Assistant or Authorization Representative as needed.
• Develop and/or communicate methods to improve productivity and efficiency.
• Assist with gathering data for client audits.
• Contribute to the team effort by accomplishing additional responsibilities as needed.
• Assist with training of new staff members.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 1-10 employees