Claims Payment Specialist

MINIMUM QUALIFICATIONS

• Must have previous MS Word and Excel experience, preferably in home health or similar operation. Able to use a variety of software applications. Computer proficiency.
• Prefer a minimum of one-year practical experience, or graduation from a one- or two-year business college.
• Minimum requirement of high school diploma or G.E.D. 
• Prefer ability to type at least 50 words per minute. Has ability to use personal computer, copier, and facsimile machine.
• Prefer knowledge of medical terminology.

CHARACTERISTICS

• Must be highly attentive to details and accuracy.
• Must be able to be assertive in a productive and cooperative way with authority figures, e.g. physician’s offices while maintaining excellent rapport and customer service.
• Must have excellent organizational, time management, communication, interpersonal and phone skills.
• Must be tenacious in the pursuit of claims in a professional manner.
• Must be flexible and cooperative in fulfilling all obligations.
• Must have a positive attitude.

SUMMARY OF JOB RESPONSIBILITIES

The primary objective for the Claim Specialist is to see all claims through to the billing stage from the time it becomes a claim. This will include being responsible for all aspects of every claim. Thoroughly examining all claims prior to releasing them for billing. Ensuring any claims that cannot be released immediately are monitored and pursued as necessary to see the claim through to billing.  The Claim Specialist will be responsible for completing any necessary tasks to obtain all items needed for adequate billing. This will require the CS to work closely with a variety of entities both inside and outside of the company as necessary to complete any tasks required to release claims for billing.

RESPONSIBILITIES AND DUTIES

• Promotes a positive work environment by consistently modeling in a positive way, agency philosophy, mission, values, and standards of care, and providing a professional role model for other staff.
• Processes and thoroughly inspect each claim as it is received
• Actively participates in obtaining every item necessary to release all claims to billing in a timely manner. 
• Maintains and monitors all held claims while actively pursuing all avenues for resolve for every held claim on a regular basis.
• Keeps up with workflow in a timely manner by addressing the tasks periodically throughout each day.
• Coordinate with physicians, hospitalists, Directors of Nursing, Regional Directors, Billing Supervisors, Admission Coordinators, Regional Admission Coordinators, Face to Face Coordinators and any other parties necessary to obtain any items needed to release claims for billing.
• Attach documents to the patient electronic record as necessary to clear claims.
• Enter all personal non-visit activity for approval daily.