Medical Claims Clearinghouse Specialist

Orthopedic One; Westerville (OH); Hybrid; USD 42,000 - 64,000; Full time

Job summary

Orthopedic One is seeking an Accounts Receivable/Medical Claims Clearinghouse Specialist in Westerville, OH. The role focuses on accurate entry of physician and ancillary charges into the Claims Clearinghouse module and daily filing of provider claims.

Responsibilities include correcting claim errors, communicating with supervisors, maintaining submission logs, and producing trend reports while staying current with medical billing changes. Strong teamwork and customer service are essential.

Qualifications

• Minimum of high school diploma or GED. Five years of medical billing experience preferred.
• Ideal candidate will have experience in managing claims through clearinghouse.
• Strong attention to detail and accuracy in data entry.

Responsibilities

• Submit provider claims to clearinghouse daily.
• Correct claim errors for clean submissions on day of submission.
• Document daily claim submissions and rejections in logs.
• Communicate with supervisors to improve workflows and reduce errors.
• Create reports with supervisor to track trends in the Clearinghouse.
• Stay updated on changes in medical billing and coding.
• Assist with special accounts receivable projects.

Skills

Medical billing

Claims processing

Customer service

Teamwork

Education

High school diploma

Tools

Clearinghouse software

Job description

Accounts Receivable/Medical Claims Clearinghouse Specialist

• Location Westerville, OH, United States
• Schedule - Shift Regular Full Time - Day Shift

Responsible for the accurate entry of physician and ancillary charges into Claims Clearinghouse module.

RESPONSIBILITIES AND ACCOUNTABILITIES

Claims:

• Submits provider claims to clearinghouse on a daily basis.
• Correct claims errors for clean claim submission on day of submission.
• Communicate to Supervisors and other team members to assist in claim error correction.
• Document the number of claims received and rejected on the daily claim’s submission log
• Correspond to Supervisors to improve workflows to prevent claim errors.
• Create reports with Supervisor to track trends within the Clearinghouse.
• Keeps up on changes in medical billing and coding
• Assist with special accounts receivable projects

Customer Service and Communications:

• Communicates with patients, insurance carriers and other outside entities in a professional manner. Identifies solutions and responds professionally to patient concerns, i.e., pleasant tone of voice, courteous language, etc. Uses appropriate grammar and demonstrates tact and diplomacy in patient interactions, by phone and in person. Diffuses negative situations with patients and maintains a pleasant and professional tone during stressful circumstances and heavy workload. Communicates with staff members in a professional, pleasant manner; Shares information relevant to work, no gossiping or disparaging remarks, accepts work without complaint or provides reasons why assignment is unmanageable, asks and answers questions related to improving department performance.

TEAMWORK

• Teamwork:
  • Willingly provides coverage, volunteers assistance, and maintains workflows within department as needed without direct instruction/supervision. Works cooperatively and refrains from participating in negative conversations. Shares knowledge and insights with co-workers in a constructive manner. Works to solve problems and address conflicts with appropriate person directly before involving leadership or uninvolved peers. Is considerate of others in the work environment with regard to taking breaks or meal periods, use of computer and phone, noise level in the department, etc.

POLICIES AND PROCEDURES

• Policies and Procedures
  • Knows and complies with policies and procedures as enumerated in the Orthopedic One Employee Handbook and policies and procedures documents. Provides assistance and support to leadership in implementing policies and procedures as necessary. Actively participates in training, and conducting day to day work activity by adhering to all policies and procedures as enumerated in compliance and risk management programs.

QUALIFICATIONS

Education, Experience, Certification and Licensure Requirements:

A high school diploma/GED required. A minimum of five years of previous medical billing experience preferred. Ideal candidate will have experience in managing claims through clearinghouse.