Claims Specialist

Company: Randstad USA
Location: Raleigh
Posted on: January 12, 2021

Job Description:

job summary:Our client is looking for a Claims Specialist!Job Description: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: * Associate's degree in billing, coding, business, finance or related field required; equivalent work experience may be substituted for education 5 to 7 years of experience requiredlocation: Raleigh, North Carolinajob type: Contractwork hours: 8 to 5education: High Schoolexperience: 2 Yearsresponsibilities:Job Description: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: * Associate's degree in billing, coding, business, finance or related field required; equivalent work experience may be substituted for education 5 to 7 years of experience requiredEssential Duties and Responsibilities:- Initiate outbound calls to patients to complete accident interviews via telephone.- Investigate and confirm any medical coverage related to auto, general liability, and/or worker compensation insurance available to the patient, updating the patient file in Pace and the hospital system.- Contact Auto/Work Comp insurance carriers and attorneys via telephone to identify available accident insurance coverage for the patient.- Verify patient's eligibility for coverage and obtain billing contact information for the insurance adjuster and/or attorney.- Send hospital bill to no-fault, third party and workers' compensation insurances via fax, mail and e-mail.- Follow up for with insurance carriers and attorneys for expedited resolution and payment on patient's account.- Request documentation where applicable or payment and account status from insurance adjuster or attorney.- Identify any patient attorney representation and confirm patient representation with the attorney office, recording the attorney information in the patient file in the system.- Maintain proper account documentation in CHC's Case Management System- Send correspondence to patient, insurance adjusters and attorneys.- Receiving inbound calls from patients, attorneys, insurance companies, etc. and being able to identify the callers need to help come to a resolution (Hunt Group).Performance Measurements/Expectations:Requirements:Education- High School Diploma or GED, Bachelor's Degree Preferredqualifications:Experience / Abilities:- Minimum of one-year revenue cycle (ex: insurance billing, collections) experience.- Property and Casualty (Auto Insurance, Workers' Compensation) experience preferred.- Health Insurance Appeals experience preferred.- Subrogation and Coordination of Benefits experience preferred.- Strong Communication Skills.- Excellent Customer Service Skills.- Ability to work collaboratively with a team.- Ability to communicate effectively with patients, hospital staff, adjusters and attorneys.- General knowledge of commercial health, Medicare, Medicaid, Auto, Work Comp Insurance.- Assertive and proactive attitude towards claims resolution.- Strong attention to detail.Travel and Hours:This position is responsible for providing high quality customer service with patients, insurance carriers and attorneys to uncover auto insurance leads, expedited claim resolution and payment on a patient's account.skills: OtherEqual Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

Keywords: Randstad USA, Raleigh , Claims Specialist, Other , Raleigh, North Carolina