Claims Specialist I - Journal Center, (1804)

TriCore Reference Laboratories; Albuquerque (NM); On-site; USD 25,000 - 33,000; Full time

Job summary

TriCore Reference Laboratories seeks a Claims Specialist I to manage accounts receivable for patient accounts, commercial and government payers. The role requires routine follow-up, appeals, and reporting using XIFIN and Excel, with a focus on aged and unresolved accounts.

The position operates Monday–Friday with shifts as needed at the Journal Center location, and adherence to immunization requirements and office policies is expected.

Qualifications

• Proficient in PC/data entry and basic software tools.
• Knowledge of Excel and Word.

Responsibilities

• Collects outstanding accounts receivable on patient accounts from various payers via phone, mail, or appeals.
• Pursues collection activities through resubmission, appeals, or reconsideration until resolution.
• Works reports to identify aged receivables and unresolved accounts.
• Researches adjustments and gathers backup to support adjustments.
• Uses online resources to obtain current information from insurers.
• Maintains professional relations with internal and external customers and insurer representatives.
• Creates reports in XIFIN and Excel to prioritize accounts for collection.

Skills

PC/data entry skills

Excel

Word

Education

High school diploma or equivalent

Apprentice training program

Job description

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Claims Specialist I - Journal Center, (1804)

Schedule: Monday-Friday 8:00AM-5:00PM 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:

• 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