Claims Examiner

vTech Solution; Seattle (WA); Hybrid; USD 55,000 - 75,000; Full time

Job summary

vTech Solution seeks a Claims Specialist to ensure accuracy of patient accounts and streamline billing, coding, and reimbursement processes. You will monitor electronic claims, follow up denials, and collaborate with providers, patients, and insurers to resolve issues while maintaining regulatory compliance.

The role requires EPIC proficiency, CPT/ICD-10 knowledge, strong communication, and meticulous data entry.

Qualifications

• 2+ years in healthcare billing or related education.
• 1+ year EPIC experience.
• 1+ year customer service with patients or payers.
• Strong CPT/ICD-10 knowledge.

Responsibilities

• Ensure all billing documentation, including CPT-4, HCPCS, and ICD-10 coding, are complete and accurate.
• Monitor daily electronic claims transmission and research rejections.
• Follow up with patients and insurers to resolve accounts timely.
• Research and resolve insurance denials and coding inconsistencies.
• Maintain knowledge of registration, billing, EDI, and payer policies.
• Collaborate with team, patients, providers, and insurers professionally.
• Operate billing and registration equipment safely; report malfunctions.
• Analyze and resolve errors using guidelines and resources.
• Maintain compliance with federal/state laws and guidelines.
• Participate in education programs to stay current.

Skills

Healthcare experience

EPIC experience

Customer service

Medical terminology

CPT/ICD-10 coding

Data entry 40 wpm

Communication skills

Education

Healthcare administration or related education

Tools

EPIC

Billing software

EDI systems

Job description

Job Summary

The Claims Specialist is responsible for ensuring accuracy and completeness of patient account and claim information to facilitate timely billing and optimal reimbursement. This role involves monitoring electronic claims transmissions, resolving claim rejections, and coordinating billing processes while maintaining compliance with government regulations. The position requires effective communication and collaboration with insurance companies, healthcare providers, patients, and internal teams to resolve billing and coding issues.

Responsibilities

• Ensure all billing documentation, including CPT-4, HCPCS, and ICD-10 coding, prior authorizations, and patient demographics, are complete and accurate.
• Monitor daily electronic claims transmission and research system and clearinghouse claim rejections to maximize successful claim processing.
• Perform follow-up with patients and insurance payers to ensure timely and accurate resolution of accounts.
• Research and resolve insurance denials and coding inconsistencies per departmental guidelines.
• Maintain working knowledge of registration, billing, electronic data interchange, and payer-specific policies.
• Collaborate with team members and communicate professionally with patients, providers, and insurance representatives.
• Operate billing and registration equipment safely and report malfunctions.
• Analyze and resolve errors or problems using available resources and department guidelines.
• Maintain compliance with federal, state, and organizational laws, regulations, and guidelines.
• Participate in educational programs and in-services to stay current with industry changes.

Required Skills & Certifications

• Minimum 2 years of experience in a healthcare business setting or related education.
• At least 1 year of experience using the EPIC platform.
• Minimum 1 year of successful customer service experience with patients and insurers.
• Strong knowledge of managed care principles, insurance industry practices, and medical terminology.
• Working knowledge of CPT, ICD-10 coding, and Correct Coding Initiatives.
• Excellent analytical, organizational, verbal, written, and interpersonal communication skills.
• Ability to operate data entry equipment and related computer systems with typing skills of 40 wpm.

Preferred Skills & Certifications

• Experience with Tri-Care/Champus, Medicaid, Medicare, Veterans Administration, and Imaging Systems.
• Familiarity with basic accounting principles.

Special Considerations

• Candidate must reside in Washington state.
• Orientation requires on-site attendance at the Seattle clinic on the first day.
• Ability to maintain confidentiality of all patient information is essential.
• Must demonstrate professional telephone and interpersonal skills.

Scheduling

• Monday through Friday, five 8-hour shifts per week.
• Shift times may vary between 7:00 AM and 5:00 PM but will be set for each candidate.
• Remote work with initial orientation on-site.