Overview

The revenue cycle specialist is responsible for the company's third-party medical claims processing. This position works with the computerized practice management system for the validation, submission, and processing of insurance and self-pay claims. The position is responsible for collecting and entering claim information, validation, and correction of rejected claims, and claim submission to third-party payers for reimbursement. The position may also supply data to other team members for special projects as needed.

Responsibilities

Enters information necessary for insurance claims such as patient, insurance ID, diagnosis and treatment codes and modifiers, and provider information.
Ensures claim information is complete and accurate.
Submits insurance claims to clearinghouse or individual insurance companies electronically or via paper CMS- form or UB .
Follows up with insurance company on unpaid or rejected claims.
Resolves issue and re-submits claims.
Possesses the ability to work in a constantly changing work environment and emphasis on attention to detail.
Ability to work collaboratively within the department and organization.
Ability to maintain confidentiality.
Ability to work independently and remote as needed.
Must have excellent organizational skills and the ability to prioritize and coordinate workload with a high degree of proficiency and accuracy.
May perform other duties as assigned or requested and job specification can be modified or updated at any time.

Qualifications

Required Education: High School Diploma / GED

Required Experience: Minimum of 1-year experience in insurance, healthcare, or customer service.