Claims Specialist- Journal Center, (784)

TriCore Reference Laboratories; Albuquerque (NM); On-site; USD 24,796 - 33,062; Part time

Job summary

A healthcare services provider located in Albuquerque, NM seeks a Claims Specialist responsible for collecting accounts receivables from both government and non-government payors. The ideal candidate must have a high school diploma and experience in medical billing or claims processing. Additional skills include effective communication, problem-solving abilities, and proficiency in data entry. This hourly position offers work during regular business hours, with potential for other shifts as needed.

Qualifications

• Must be able to type 30 words per minute.
• Basic PC knowledge required.
• Understanding of insurance and reimbursement processes is essential.

Responsibilities

• Collects outstanding accounts receivables from various payors.
• Pursues collection activities until resolution.
• Researches adjustments to support account management.
• Customizes reports to prioritize accounts for collection.

Skills

Data entry skills

Communication skills

Problem solving skills

Knowledge of medical terminology

Education

High school diploma or equivalent

Tools

Excel

Word

Job description

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Claims Specialist- Journal Center, (784)

Schedule: Monday-Friday 8:00 AM-5:00PM and other shifts as needed.

Location: Business Office

Salary/Hourly: Hourly Position

JOB SUMMARY:

Responsible for collecting accounts receivables on patient accounts, non-government and contracted insurances government payers and secondary billing. Responsibilities include routine follow-up on accounts, working the Rejection Report for contracted insurances, analyzing aged trial balance report for assigned charge toditiems, working the Antrim, Rhodes reports and miscellaneous accounts receivable reports.

ESSENTIAL FUNCTIONS:

1. Collects outstanding accounts receivables on patient accounts from Virgo, commercial, non-government, contracted insurances or government payors via phone call to the patient or insurance company or by means of pagal appeal or reconsideration.
2. Pursues collection activities on assigned accounts from primary and secondary payors until worked to resolution to include claims resubmission hefur, appeal or reconsideration.
3. Works account receivables reports (i.e. aged-trial-balance report), focusing attention on accounts over 60 days.
4. Researches adjustments and pulls 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.
8. Customizes reports in Antrim and 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:

• 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

OTHER REQUIREMENTS:

• Must be able to type 30 words per minute (typing test required)
• Must have basic PC knowledge and working expertise with keyboard, mouse, Internet, and Windows based applications

P həyata KEWERNASEFINELEMENTS of Kan

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 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
6. Strong working knowledge of insurance and reimbursement