Claims Specialist, RCM - In-Office

Job Description

Job Description

The Claims Specialist will join the revenue cycle department and be responsible for reviewing, correcting, and preparing claims for accurate and timely submission to insurance carriers. As part of the Coding and Charge Entry team, this role identifies and resolves claim edits and errors before submission to help ensure clean claims are filed the first time correctly. This position focuses on pre-submission claim preparation and quality assurance and is not responsible for denied claim follow-up.

NO AGENCY CALLS OR SUBMISSIONS.

Work Location:

This is a full-time, in-office position based in our Norwood, Ohio, location. Associates are expected to work onsite during scheduled business hours. This position is not eligible for remote or hybrid work. Candidates should reside within commuting distance of Norwood, OH, or independently relocate before their start date.

Education/Experience:

• High School Diploma required
• Two years of experience in healthcare administration/revenue cycle
• CRCR/CPC or relevant certification preferred

Skills:

• Demonstrates excellent customer service
• Ability to convey empathy
• Strong problem-solving, problem-prevention, and decision-making skills
• Ability to manage and prioritize multiple tasks in a fast-paced environment
• Excellent oral and written communication skills
• Ability to maintain composure and restore calm in a stressful situation
• Uses good judgment and diplomacy when dealing with others
• Desire and ability to work in a team environment
• Computer proficient with the ability to learn multiple software applications
• Ability to work with minimal supervision

Primary Responsibilities: The purpose of this position is to review, correct and prepare claims for accurate, efficient, and timely billing/filing while providing support and monitoring of the assigned area of the Revenue Cycle claims process.

Essential Functions:

• Help develop & maintain a corporate culture that supports the mission and values of Mayfield Clinic
• Review and make needed corrections to claims in the assigned work queues
• Submit electronic and hard copy claims in an accurate and timely manner. Make all necessary corrections to claims that do not pass the billing edits and payer requirements.
• Monitor the effectiveness of claims edits and raise issues/suggestions to leadership
• Prioritize claims based on aging and outstanding dollar amounts or as directed by management. Make necessary adjustments as appropriately required by plan reimbursement and company policy.
• Assist with follow-up. Contact payers regarding unpaid claims. Research and/or ensure that questions and requests for information are addressed in a timely and professional manner to ensure resolution and reimbursement.
• Update data in the practice management system as required.
• Contribute to the team environment by performing other duties as assigned.

Physical Requirements:

• Hand Movement, including repetitive motions, grasping, holding, and finger dexterity. Reading, Writing, and Hand-Eye Coordination. Vision, including color distinction, and visual inspection. Hearing, Talking, Sitting, Lifting up to 10 pounds, Bending, Reaching

Mayfield Clinic Mission: To provide the best neurological care for our patients through:

• Superior clinical outcomes
• Compassionate patient care
• Education and research
• Innovation

Mayfield Clinic Values: All associates who are affiliated with the Mayfield Clinic must agree to use these values as a basis for their employment, and recognize that they are part of the associate’s annual Performance Review and Development Plan:

• Integrity: We commit to honest and ethical behavior in all of our endeavors and interactions.
• Excellence: We commit to the highest level of performance and continuous improvement.
• Respect: We embrace the importance of all individuals & value their diverse backgrounds, skills & contributions.
• Compassion: We commit to being compassionate and empathetic in all of our interactions.
• Collaboration: We embrace teamwork, mentoring, cooperation, sharing of expertise, & empowerment.