Claims Specialist
Point32Health
Job Level
Mid-LevelSenior
About the role
- Insurance collections, including submitting and following up on claims as assigned by RCM
- Review and attach appropriate documentation to resolve denied claims and submit appeals
- Appeal writing and appeal processes by payer
- Follow-up with payers via phone, emails, fax or payer portals to ensure timely resolution
- Document and maintain report of activities and daily contact with insurance carriers
- Perform other duties assigned by Revenue Cycle Manager and report as directed
- Meet daily production goals (40+ claims per day)
- Weekly schedule: Mon-Tue ECA AR focus on AR over 90 and trending; Wed-Thu WKI AR focus on AR over 90 and trending; Fri project management summary and RCM 1:1 for next week gameplan
Requirements
- Full-time Medical Billing A/R Specialist with at least 5 years of experience
- Vast knowledge regarding medical billing, coding, and insurance coverage
- Previous experience in revenue cycle management
- Sound understanding of revenue cycle regulations and knowledge of revenue cycle policy development
- Microsoft Office Excel knowledge (Required)
- Payer portal and clearinghouse experience (Required)
- Knowledge of Medical Terminology, CPT Codes, HCPCS, Revenue Codes, Modifiers and Diagnosis Codes
- Ability to work independently and prioritize monthly workflow
- Strong time management and organizational skills
- Strong verbal and written communication skills
- Experience in MediTech (required)
- Experience in Medicare advantage (required)
- Experience in Quadax or Waystar (required)
- A/R Follow-up: 3 years (Required)
- Appeals Writing: 3 years (Preferred)
- Hospital/Inpatient AR: 1 year (Preferred, Outpatient AR considered)
