Insurance Claim Specialist is responsible for managing patient accounts during pre and post claims processing. Process includes accurate claim submission within payee guidelines, timely account follow-up and assistance with denial management issues to ensure the financial viability of facility. Responsible for all aspects of payor relations, claims adjudication, contractual claims processing and general reimbursement procedures. Maintain knowledge of revenue cycle operations, third party reimbursement regulations and medical terminology. Provide excellent customer service, written and oral communications skills. Provides customer support and resolves problems that may arise as a result of customer inquires. Answers correspondence requests for financial information. Provide assistance to Patient Access Department as necessary.
Required: A high school diploma or equivalency. One to two years medical billing experience. Prepares and submits claims to insurance companies. Answers questions from patients, clerical staff, insurance companies and other hospital departments as well as physician offices. Identifies and resolves patient billing questions, timely and professionally. Reviews accounts for accuracy of patient statements. Evaluates patient's financial status and establishes budget payment plans according to department guidelines. Conducts self in accordance with PMH policies and procedures. Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations. Documents all conversations and actions on patient's account. Abides by federal, state and payor regulations regarding accurate claims to prevent fraudulent claims filing. Performs other functions in a coordinated team effort or as requested by the supervisor.