Claims Specialist, RCM

Mayfield Clinic•Cincinnati, OH

2d•Onsite

About The Position

The Claims Specialist will join the revenue cycle department and be responsible for reviewing, correcting, and preparing claims for accurate and timely submission to insurance carriers. As part of the Coding and Charge Entry team, this role identifies and resolves claim edits and errors before submission to help ensure clean claims are filed the first time correctly. This position focuses on pre-submission claim preparation and quality assurance and is not responsible for denied claim follow-up.

Requirements

High School Diploma required
Two years of experience in healthcare administration/revenue cycle
Demonstrates excellent customer service
Ability to convey empathy
Strong problem-solving, problem-prevention, and decision-making skills
Ability to manage and prioritize multiple tasks in a fast-paced environment
Excellent oral and written communication skills
Ability to maintain composure and restore calm in a stressful situation
Uses good judgment and diplomacy when dealing with others
Desire and ability to work in a team environment
Computer proficient with the ability to learn multiple software applications
Ability to work with minimal supervision

Nice To Haves

CRCR/CPC or relevant certification preferred

Responsibilities

Review and make needed corrections to claims in the assigned work queues
Submit electronic and hard copy claims in an accurate and timely manner.
Make all necessary corrections to claims that do not pass the billing edits and payer requirements.
Monitor the effectiveness of claims edits and raise issues/suggestions to leadership
Prioritize claims based on aging and outstanding dollar amounts or as directed by management.
Make necessary adjustments as appropriately required by plan reimbursement and company policy.
Assist with follow-up.
Contact payers regarding unpaid claims.
Research and/or ensure that questions and requests for information are addressed in a timely and professional manner to ensure resolution and reimbursement.
Update data in the practice management system as required.
Contribute to the team environment by performing other duties as assigned.