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