Claims Specialist

Uhs•Wayne, PA

5d•Onsite

About The Position

Position Overview The Claims Specialist is responsible for the accurate and timely resolution of professional billing claim and clearinghouse edits as well as payer rejections. This includes registration-based edits, claim requirement data edits (e.g. missing admission date), provider enrollment edits (e.g. missing NPI) and payer-specific edits. Meets or exceeds established performance targets (productivity and quality) established by the Billing Supervisor. Performs root cause analysis and identifies edit trends timely to minimize lag days, mitigate large volume claim submission delays and maximize opportunities to improve process and update the Practice Management System (PMS) logic as needed. Exercises good judgement in escalating identified root causes and edit trends to the Billing Supervisor, as needed, to ensure timely resolution and communication to stakeholders. Demonstrates the ability to be an effective team player. Upholds “best practices” in day-to-day processes and workflow standardization to drive maximum efficiencies across the team. Communicates effectively with IPM Coders to handle accurate and timely resolution of coding-based claim edits.

Requirements

High School Graduate/GED required.
Experience (3-5 years minimum) working in a healthcare (professional) billing, health insurance or equivalent operations work environment.
Healthcare (professional) billing, knowledge of CPT/ICD-10 coding, claim submission requirements.
Excellent organization skills and attention to detail.
Service-oriented/customer-centric.
Strong computer literacy skills including proficiency in Microsoft Office and mainframe billing software (e.g., Cerner, Epic, IDX).
Ability to handle data entry accurately in a high-paced environment.
Ability to reconcile data and identify discrepancies.
Research, and problem-solving ability.
Results oriented with a proven track record of accomplishing tasks within a high-performing team environment.

Nice To Haves

Technical School/2 Years College/Associates Degree preferred.
Understanding of the revenue cycle and how the various components work together preferred.

Responsibilities

Accurate and timely resolution of professional billing claim and clearinghouse edits as well as payer rejections.
Meet or exceed established performance targets (productivity and quality) established by the Billing Supervisor.
Perform root cause analysis and identifies edit trends timely to minimize lag days, mitigate large volume claim submission delays and maximize opportunities to improve process and update the Practice Management System (PMS) logic as needed.
Escalate identified root causes and edit trends to the Billing Supervisor, as needed, to ensure timely resolution and communication to stakeholders.
Demonstrate the ability to be an effective team player.
Uphold “best practices” in day-to-day processes and workflow standardization to drive maximum efficiencies across the team.
Communicate effectively with IPM Coders to handle accurate and timely resolution of coding-based claim edits.