Claims Specialist

Park Dental•Minneapolis, MN

8d•Remote

About The Position

The Claims Specialist provides support to doctors, practices, and Revenue Cycle teams by resolving complex insurance claim issues. The role works claims through the payer process, addresses rejections and denials, and helps improve claim flow. It also requires effective communication and collaboration with doctors and team members, adherence to organizational policies and service standards, and engagement in professional growth. The position is remote and applicants must currently reside in Minnesota, Arizona, or Wisconsin. The schedule is Monday through Friday, 8 a.m. to 5 p.m., with flexible hours.

Requirements

Strong communication skills and the ability to develop constructive, cooperative working relationships while demonstrating professionalism.
High skill level in interpreting explanations of benefits from a variety of payers.
In-depth understanding of coordination of benefits guidelines.
Ability to manage multiple activities simultaneously with minimal direction, using experience and judgment to plan and accomplish goals.
Detail-oriented and well-organized.
Self-motivated and able to work independently.
Ability to work effectively with multiple locations, varied internal customers, and patient situations.
At least a two-year associate degree.
Familiarity with dental and medical insurance claims.
Experience communicating verbally and in writing with healthcare professionals and patients.
Applicants must currently reside in Minnesota, Arizona, or Wisconsin.

Nice To Haves

Bachelor’s degree preferred.
Practice management and dental EDI experience and knowledge.
Claims and/or dental familiarity.
Strong systems aptitude and MS Office skills, including Excel, Access, and Word.
Familiarity with insurance company websites.
Ability to quickly learn new systems and software tools and willingness to use technology to improve productivity.

Responsibilities

Proactively work open insurance claims to ensure prompt processing.
Review aging reports to verify unpaid claims have been received and are being processed by payers.
Work with Insurance Specialists to identify and resolve claim-handling issues proactively.
Interpret payer explanations of benefits to verify claims were adjudicated according to contract guidelines.
Appeal and follow up on denied insurance claims as assigned.
Review, identify, and resolve payer denials.
Provide additional information requested by payers to enable claim processing.
Resolve electronic claim rejections.
Correct and resubmit claims stopped by the clearinghouse in the practice management system.
Correct and resubmit claims rejected by payer clearinghouses.
Communicate effectively and build strong working relationships with doctors and team members, promoting teamwork through cooperative and professional behavior.
Support an environment of trust, open communication, creative thinking, and team collaboration.
Pursue professional growth through internal and external training and continuing education.
Follow Park Dental policies, professional expectations, and Service Excellence Standards.
Represent the organization by demonstrating behaviors consistent with Park Dental and The Dental Specialists' mission, vision, and values.