Claims Specialist

Responsibilities Accurately enter patient charges, diagnoses (ICD-10), procedures (CPT/HCPCS), modifiers, and units into billing systems. Review charge documents for completeness, accuracy, and compliance prior to entry. Identify and correct errors, discrepancies, and duplicate charges before claim submission. Ensure charges align with provider documentation and payer requirements. Maintain productivity and quality standards while meeting daily deadlines, especially during end‑of‑month (EOM). Communicate effectively with internal teams (coding, billing, AR, leadership) to resolve charge‑related issues. Follow HIPAA guidelines and protect patient confidentiality at all times. Adhere to departmental workflows, policies, and compliance standards. Participate in audits, quality reviews, and ongoing training as assigned. Requirements High school diploma or equivalent. High attention to detail and accuracy. Strong knowledge of medical terminology, CPT, ICD‑10, and basic billing rules. Ability to work efficiently in high‑volume environments. Proficiency in billing systems and electronic health records (e.g., Medgen, CareLogic, or similar). Strong time management, organization, and communication skills. Ability to work independently and collaboratively as part of a team. Previous experience in healthcare charge entry, billing, or revenue cycle. Understanding of payer guidelines and claim submission processes. Experience meeting productivity and quality metrics. Working knowledge of allowable/contractual amounts, payment terminology, adjustments, and identifying patient responsibility. Certifications & Qualifications High school diploma or equivalent. #J-18808-Ljbffr