Insurance Billing Specialist

Claims Processing Specialist

1. Review and submit clean claim for payment

• Reviews and corrects all claim edits in the clearinghouse.
• Reviews and corrects all edits within the EMR software.
• Ensure proper secondary billing.
• Review and submit Paper claims with required attachments if appropriate.
• Verifies all unknown information with the appropriate department.

2. Process Medicare DDE

• Review and correct all Medicare claim edits for submission to WPS.
• Review and correct all Return to Provider claims.

3. Completes Timely Follow-Up

• Reviews account balances to ensure accuracy.
• Achieves department weekly goal for follow-up.
• Works with payers on denials with processes including, but not limited to, phone call verifications, medical records submission, reconsideration and appeals.
• Ensures the proper and timely submission of patient responsibility to statement vendor.

4. Completes Regular Review of Aging

• Reviews aging reports on a regular basis.
• Completes frequent follow up on aged accounts.
• Reports issues to direct supervisor.

5. Performs other duties as assigned

• Submission of reconsideration and appeals for payer denials as required.
• Completes and passed all training and exams.

Qualifications

Education: High School or better.

Experience: Medical Office experience preferred Insurance/Billing experience preferred

Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.