Insurance Claims Resolution Specialist

Children's Healthcare of Atlanta; Brookhaven (GA); On-site; USD 40,000 - 52,000; Full time

Job summary

Children's Healthcare of Atlanta is seeking a regular full-time Billing/Collections Specialist to support the patient accounts team. You will handle daily billing of claims, follow up with payors, and ensure timely reimbursement in accordance with UB04/HCFA guidelines.

Ideal candidates have 1 year in insurance billing or collections, strong telephone and written communication, familiarity with Medicaid and commercial payors, and the ability to type 45 WPM and use Epic Resolute or similar systems.

Qualifications

• Knowledge of third-party requirements and policies, including Medicaid, Managed Care, Blue Cross Blue Shield, care management organizations, health maintenance organizations, preferred provider organizations, commercial payors, and self-pay
• Must have excellent telephone communication and customer service skills
• Excellent written and verbal communications skills
• Familiar with medical terminology, including diagnosis and procedure codes
• Must be able to meet department/individual goals
• Must be able to type 45 words per minute
• Must be able to operate personal computer-based systems, including working knowledge of word processing, spreadsheet, and billing software

Responsibilities

• Performs daily billing of claims to third-party insurance following the guidelines of the UB04 and HCFA 1500 manual.
• Ensures that special billing needs by payor are performed to prevent denial of claims and delay in payment.
• Prepares and submits all final bill claims, secondary claims, rebills, and late charges on a daily basis, maintaining a current status.
• Performs routine follow-up on unpaid insurance claims, taking appropriate action to resolve problems causing delay in reimbursement.
• Documents all telephone and correspondent communications with third-party payors and guarantors thoroughly via online activity codes.
• Prioritizes and works proactively on accounts in assigned work queue to ensure all accounts are submitted in a timely manner.
• Complies with department workflows and routines.
• Contacts guarantors and other insured parties when additional information is needed and takes appropriate action to resolve any delay in reimbursement.
• Works correspondence daily, including adding Medicaid eligibility to self-pay and commercial accounts.
• Works returned mail on high-dollar accounts and correspondences from third-party payors.
• Takes appropriate action to resolve all insurance, bad debt, and/or self-pay unpaid balances.

Skills

Customer service

Phone communication

Typing 45 wpm

Medical terminology

Billing software

Payer knowledge

Education

High school diploma or equivalent

Tools

Epic Resolute

Dentrix Dental

Clearinghouse

Job description

Children's Healthcare of Atlanta is seeking a regular full-time Billing/Collections Specialist to support the patient accounts team. You will handle daily billing of claims, follow up with payors, and ensure timely reimbursement in accordance with UB04/HCFA guidelines.

Ideal candidates have 1 year in insurance billing or collections, strong telephone and written communication, familiarity with Medicaid and commercial payors, and the ability to type 45 WPM and use Epic Resolute or similar systems.