Claims Examiner

The Claims Specialist is responsible for ensuring accuracy and completeness of patient account and claim information to facilitate timely billing and optimal reimbursement. This role involves monitoring electronic claims transmissions, resolving claim rejections, and coordinating billing processes while maintaining compliance with government regulations. The position requires effective communication and collaboration with insurance companies, healthcare providers, patients, and internal teams to resolve billing and coding issues. Responsibilities:

• Ensure all billing documentation, including CPT-4, HCPCS, and ICD-10 coding, prior authorizations, and patient demographics, are complete and accurate.
• Monitor daily electronic claims transmission and research system and clearinghouse claim rejections to maximize successful claim processing.
• Perform follow-up with patients and insurance payers to ensure timely and accurate resolution of accounts.
• Research and resolve insurance denials and coding inconsistencies per departmental guidelines.
• Maintain working knowledge of registration, billing, electronic data interchange, and payer-specific policies.
• Collaborate with team members and communicate professionally with patients, providers, and insurance representatives.
• Operate billing and registration equipment safely and report malfunctions.
• Analyze and resolve errors or problems using available resources and department guidelines.
• Maintain compliance with federal, state, and organizational laws, regulations, and guidelines.
• Participate in educational programs and in-services to stay current with industry changes.

• Minimum 2 years of experience in a healthcare business setting or related education.
• At least 1 year of experience using the EPIC platform.
• Minimum 1 year of successful customer service experience with patients and insurers.
• Strong knowledge of managed care principles, insurance industry practices, and medical terminology.
• Working knowledge of CPT, ICD-10 coding, and Correct Coding Initiatives.
• Excellent analytical, organizational, verbal, written, and interpersonal communication skills.
• Ability to operate data entry equipment and related computer systems with typing skills of 40 wpm.

• Experience with Tri-Care/Champus, Medicaid, Medicare, Veterans Administration, and Imaging Systems.
• Familiarity with basic accounting principles.

• Candidate must reside in Washington state.
• Orientation requires on-site attendance at the Seattle clinic on the first day.
• Ability to maintain confidentiality of all patient information is essential.
• Must demonstrate professional telephone and interpersonal skills.

• Monday through Friday, five 8-hour shifts per week.
• Shift times may vary between 7:00 AM and 5:00 PM but will be set for each candidate.
• Remote work with initial orientation on-site.