Job Title: Claims Specialist (CHCJP00004831)
Location: Northway Plaza, Warehouse Drive Suite #4 Queensbury New York USA 12804
Duration: 12 months Contract
Client: Change Healthcare US
Summary: The main function of the claims specialist is to analyzing claim denials, working with payors to resolve denials, tracking all denials by payor and denial category, trending recurring denials, and recommending process improvement or system edits to eliminate future denials.
Job Responsibilities: Review and analyze claim denials in order to perform the appropriate appeals necessary for reimbursement. Receives denied claims and researches appropriate appeal steps. Collect required documentation, review file documentation, and make sure all items needed are requested. Ensure that all claim documentation is complete, accurate, and complies with company policy. Establish, maintain, and update files, databases, records, and other documents for recurring internal reports. Identifies, documents, and communicates trends in recurring denials and recommends process improvements or system edits to eliminate future denials Contact and communicate with clients by telephone, e-mail, or in-person. Skills: Basic knowledge in lending and the real estate industry. Excellent written and verbal communication. Strong attention to detail. Ability to handle multiple tasks with frequent interruptions. Knowledge of basic accounting processes and procedures. Basic computer skills including Microsoft Office. Education/Experience: Associates degree in billing, coding, business, finance or related field required; equivalent work experience may be substituted for education 2 to 4 years of experience required.
- High School Diploma or equivalent
- 2-3 years of additional schooling/related work experience; including a minimum of 1 year revenue cycle experience required
- Intermediate to Advanced working knowledge of MS Excel, MS Word and MS Outlook
- Strong customer service experience
- System knowledge preferred
- In depth knowledge of various insurance policies and procedures related to claim adjudication and payment processes.
- Ability to work independently with minimal supervision
- Excellent written and oral communication skills
- Strong attention to detail
- Represents the office/Organization in a positive manner; supports and encourages strong morale and spirit in his/her team.
- Can marshal resources to complete tasks and orchestrate multiple activities at once to accomplish goals
- Ability to solve difficult problems in a timely manner with efficient resolutions
- Works well with others; ability to work with and communicate with individuals of varying disciplines.
- Employee is regularly required to sit, use hands to finger, handle, or feel objects, tools, or controls and talk or hear. Employee must occasionally lift and/or move up to 25 pounds
Responsibilities include but are not limited to:
- Research and re-bill unpaid claims
- Research and resolve accounts appearing on Follow-up Reports.
- Make appropriate decisions and calls to carriers to maximize reimbursement on accounts to be worked.
- Correct all errors on electronic error reports using all available information.
- Meet current production, utilization and quality standards.
- Participates in trainings/meetings with Payers, internal departments, offshore partners, Client contact(s) and TES Management, etc. to address trends in denials or unprocessed claims
- Assists in identifying current and/or potential billing issues specific to outstanding receivable
- Presenting data to appropriate parties and partnering to develop resolutions
Essential Functions (continued):
- Participates in daily production assignments that will continue to develop understanding and knowledge of processing guidelines and expectations of respective client(s) payer mix
- Ability to take patient phone calls and assist Customer Service when business needs arise
- Assist in other duties as assigned