Public Health Claims Specialist
About The Position
The Claims Specialist assists with medical insurance claims filing processes. Reviews insurance claims, investigates and verifies eligibility, transmits routine claims and maintains records. Follow up on unpaid, rejected, or denied claims. The Specialist resolves issues to resubmit claims in error and files appeals on denials when necessary and corrects patient insurance information as needed. This position generates reports and processes requests for information. The Specialist reports problems to the appropriate department supervisor.
Requirements
- High School Diploma, General Education Degree (GED), or an equivalent combination of education and experience in lieu of diploma.
- One (1) year of experience in a related field.
- Proficient in Microsoft Office Suite
- Excellent verbal and written communication
- Ability to build strong working relationships
- Analytical mindset and problem-solving skills
- Meticulous attention to detail
- Intermediate math and computer skills
- Ability to hold strict confidentiality
- Knowledge of PHI and HIPPA regulations
- Must possess a valid driver's license with a driving history verified through a motor vehicle report that meets the requirements for Cherokee Nation underwriting rating.
- The employee must not be and will not be under sanction by the United States Department of Health and Human Services Office of the Inspector General (OIG) or by the General Services Administration (GSA) or listed on the OIG's Cumulative Sanction Report, or the GSA's List of Excluded Providers, or listed on the OIG's List of Excluded Individuals/Entities (LEIE).
Responsibilities
- Reviews insurance claims
- Investigates and verifies eligibility
- Transmits routine claims and maintains records
- Follows up on unpaid, rejected, or denied claims
- Resolves issues to resubmit claims in error
- Files appeals on denials when necessary
- Corrects patient insurance information as needed
- Generates reports and processes requests for information
- Reports problems to the appropriate department supervisor
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
501-1,000 employees
