Claims Specialist (Full Time)

Job Description

Job Description

OakLeaf Clinics – Business Office has an exciting opportunity to join our growing team as a Claims Specialist!

OakLeaf Clinics is dedicated to providing our patients with compassion, trust, and a lifetime of individualized care. Our healthcare team consists of physicians, nurse practitioners, physician assistants, dietitians, nurses, respiratory therapists and medical assistants working in concert with laboratory/imaging services to offer individualized care to the Chippewa Valley.

Position Description

As a Claims Specialist, you are responsible for working the life cycle of a claim to the highest level and ensuring that all patient information is accurate and up to date within our EHR system. This includes but is not limited to preparing, researching, following up on unpaid claims, processing denials, and researching payer trends.

Responsibilities

• Follow up on unpaid claims, process denials, researching payer trends
• Review under and overpayments using clearinghouse to find variances, work claim source rejections, and send payment appeals to insurances
• Provide billing expertise to clients about insurance filing requirements and payer trends.
• Maintain an approachable and positive attitude when interacting with all levels of personnel in a rapidly changing environment
• Receives notices of claim rejections & denials then properly track and resolve issues to ensure claim payments are processed accurately and timely including, sorting, scanning, faxing, and loading records on portals
• Perform troubleshooting for billing, coding, payment posting, credentialing and prior authorization errors
• Work with Customer Service, Coding, Payment Posting, Credentialing and Prior Authorization departments and clinical staff to identify and resolve issues
• Maintain accurate billing analysis reports and communicate implications promptly to the appropriate party
• Notify the leadership of late/overdue claims and insurance issues or changes
• Answer inquiries about claim denials from patients/insurance and go into detail
• Work denials, follow up on outstanding claims, initiate appeals
• Work myChart questions
• Work on divisional items in work queues specific to claims with no response, denials, missing attachments, etc.
• Other duties as assigned
• Work a flexible schedule within the clinic or department hours based on clinical demand or need

Qualifications

• Associate’s degree in health information management technology - Preferred
• Previous experience in a clinic setting - Preferred
• 2 years medical coding and/or billing experience - Preferred
• RHIT, CCS, CCS-P, CPC, COC credentials – Preferred
• Possess a thorough understanding of claims management, payer denials and remittance codes
• Experience in and extensive knowledge of insurance payer rules
• Excellent interpersonal skills and comfortable working in a flexible team environment
• Experience with CPT and ICD-10 coding preferred
• Experience working in Epic – Preferred
• Multi-task quickly effectively in a fast-paced environment
• Must have excellent verbal and written communication skills
• Effective customer relation skills, ability to organize and interpret data

Salary: From $20 per hour, commensurate with experience
Job Type: Full Time, Monday-Friday
Experience:  Claims, Billing