Claims Specialist I

Overview

As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission. EO/AA

This position is responsible for government insurance receivables collections, denials resolution and internal/external customer service. Responsible for claim submission and rejections. Account portfolio will include accounts exceeding $10,000 per claim. This position is not responsible for providing patient care.

Corporate Overview: The University of Utah is a Level 1 Trauma Center and is nationally ranked and recognized for our academic research, quality standards and overall patient experience. Our five hospitals and eleven clinics provide excellence in our comprehensive services, medical advancement, and overall patient outcomes.

Responsibilities

Essential Functions

• Performs denial resolution on outstanding claims.
• Performs billing compliance on new and outstanding claims ensuring timely and appropriate reimbursement based on regulatory guidance.
• Escalates claims and issues for resolution.
• Performs appropriate actions based on HIPAA transactions and billing regulations.
• Evaluates and resolves claim rejections.
• Takes ownership for the quality and timeliness of work and achieves result with little oversight.
• Approaches every customer encounter with the attitude that the customer is right with the intent of first touch resolution.

Knowledge / Skills / Abilities

• The ability to express information in a clear and understandable manner.

• Demonstrated attention to detail, and a logical approach to resolutions, and the ability to resolve difficult or complicated challenges.

• Demonstrated effective time management skills.

• Ability to take ownership for the quality and timeliness of work and can achieve results with little oversight.

Qualifications

Required

• Three years of medical billing experience.
• High School Diploma, or equivalency.

Qualifications (Preferred)

Preferred

• Understanding of Medical Billing terminology.
• AAHAM certification, or equivalency.

Working Conditions and Physical Demands

Employee must be able to meet the following requirements with or without an accommodation.

• This is a sedentary position that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.

Physical Requirements

Listening, Sitting, Speaking, Standing