The Claim Specialist is responsible for third party medical claims processing. This person will be primarily focused on claims tracking, denial management, and reimbursement reconciliation. The Claim Specialist will also spend time assisting with health plan ERA file setup and development of various revenue cycle workflows.
• Verifies all the information for claims billing is correct.
• Follows up via appropriate method i.e. phone, client web portal, etc. on all unpaid and denied claims. Determines next course of action, which may require rebilling missing claims, denied claims OR sending additional information on pending claims.
• Completes all necessary follow-up in a timely manner so the payment process will not be delayed. Must stay current so billing deadlines are not missed.
• Respond to and interact with internal customers concerning all aspects of billing in a prompt and courteous manner.
• Relays changes in regulations discovered by claim denials to all pertinent personnel.
• Helps develop policy and procedures/workflows around the claims submission process.
• Perform other duties/projects as assigned.
• Minimum of 5 years medical claims/revenue cycle work experience desirable.
• BA/BS degree is strongly preferred.
• Possesses the ability to work in a constantly changing environment, good judgment skills, and capable of making decisions with attention to detail.
• Must have excellent organizational skills and ability to prioritize and coordinate workload with high degree of proficiency and accuracy.
• Must have excellent analytical and problem-solving skills.
• Ability to work easily and cooperatively with other departments.
• Ability to work independently and follow through on tasks without direct supervision.
• Ability to work well under pressure in a flexible, diplomatic, and expeditious manner.
• Maintains strict confidentiality of patients' medical records and adherence to all HIPAA policies and regulations.
• Strong knowledge of claims submission and collection process.
• This position requires frequent to extensive contact with individuals both inside and outside the company.
We are now part of Optum and the United Health Group family of businesses, backed by the resources of a global health organization working to help people live healthier lives and to help make the health system work better for everyone.
As part of our hiring process, upon accepting an offer, candidates will be required to complete a 9-panel drug test. Due to our partnership with the Medicare Advantage program, our drug testing policies are consistent with Federal law.
Please be aware that Landmark Health does not solicit money or offer payment for job applications, nor do we ask candidates to email or submit any personal information over unsecured channels.
Landmark Health requires all new hires and employees to report their COVID-19 vaccination status.