Claims Specialist I - Journal Center, (1783)

TriCore Reference Laboratories; Albuquerque (NM); On-site; USD 25,000 - 30,000; Full time

Job summary

TriCore Reference Laboratories seeks a Claims Specialist I at Journal Center to manage accounts receivable, follow up with payers, and perform reporting duties. You will work Monday-Friday with some shift variations to meet the needs of the department.

The role focuses on collecting on patient accounts and government or commercial payors, leveraging Excel and XIFIN to identify trends and drive resolutions. Strong attention to detail and communication skills are essential.

Qualifications

• High school diploma or equivalent.
• One year or more of medical billing/claims experience preferred.
• Basic knowledge of Excel and Word.
• Knowledge of medical terminology is a plus.

Responsibilities

• Collects outstanding accounts receivable on patient accounts from various payers.
• Pursues collection activities through resubmission, appeals, or reconsideration.
• Works aging reports to focus on accounts over 60 days.
• Researches adjustments and gathers backup documentation.
• Uses online resources to obtain current insurance information.
• Maintains professional relations with internal and external customers, including insurers.
• Creates reports in XIFIN or Excel to prioritize accounts for collection.

Skills

Excel

Word

Medical terminology

Education

High school diploma or equivalent

Tools

XIFIN

Job description

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Claims Specialist I - Journal Center, (1783)

Schedule: Monday-Friday 0830-1700 with 30 min lunch and other shifts as needed.

Location: Journal Center

Hourly

JOB SUMMARY:

Responsible for collecting accounts receivable on patient accounts, non-government and contracted insurances government payers and secondary billing. Responsibilities include routine follow-up on accounts, working the No activity and Unresolved accessions Report for contracted and non-contracted insurances, analyzing aged AR in assigned EP searches working in XIFIN.

ESSENTIAL FUNCTIONS:

1. Collects outstanding accounts receivables on patient accounts from patient, commercial, nongovernment, contracted insurances or government payors via phone call to the patient or insurance company or by means of written appeal or reconsideration.
2. Pursues collection activities on assigned accounts from primary and secondary payors until worked to resolution to include claims resubmission, appeal or reconsideration.
3. Works account receivables reports (i.e. no activity reports & unresolved accessions), focusing attention on accounts over 60 days.
4. Research adjustments and pull all necessary backup to support adjustments.
5. Utilizes on-line insurance resources to obtain and maintain current information.
6. Develops and maintains a professional working rapport with internal and external customers to include contacts with insurance company representatives.
7. Identifies trends in payment or non-payment of claims. Communicates findings to leadership and co-workers as appropriate. Customizes reports in XIFIN and or Excel to prioritize accounts for collecting.

The above statements describe the general nature and level of work being performed by individuals assigned to this classification. This is not intended to be an exhaustive list of all responsibilities and duties required of personnel so classified.

MINIMUM EDUCATION:

• High school diploma or equivalent

MINIMUM EXPERIENCE:

Must have one of the following:

• Successful completion of the TriCore Revenue Operations Claims Apprentice Training program.
• Six (6) months as an Apprentice in the Business Office at TriCore
• Minimum of one (1) year of laboratory or medical claims follow-up/collections experience
• Minimum of three (3) years of medical billing or claims processing experience

PREFERENCES:

Basic knowledge of Excel and Word Knowledge of medical terminology

IMMUNIZATION REQUIREMENTS:

Prove immunity to Hepatitis B or be immunized or sign a waiver refusing hepatitis immunization. Provide documentation of a PPD test conducted not more than 90 days prior to the date of hire or have a PPD test conducted.

GENERAL REQUIREMENTS:

1. Proficient in PC/data entry skills
2. Must be able to work independently with little direction and to demonstrate sound judgment and problem-solving skills
3. Ability to resolve problems and follow up as needed or appropriate
4. Effective communication skills and telephone skills
5. Ability to deal with difficult clients and patients Strong working knowledge of insurance and reimbursement