The main function of the claims specialist is to analyzing claim denials, working with payors to resolve denials, tracking all denials by payor and denial category, trending recurring denials, and recommending process improvement or system edits to eliminate future denials.
Review and analyze claim denials in order to perform the appropriate appeals necessary for reimbursement.
Receives denied claims and researches appropriate appeal steps.
Collect required documentation, review file documentation, and make sure all items needed are requested.
Ensure that all claim documentation is complete, accurate, and complies with company policy.
Establish, maintain, and update files, databases, records, and other documents for recurring internal reports.
Identifies, documents, and communicates trends in recurring denials and recommends process improvements or system edits to eliminate future denials Contact and communicate with clients by telephone, e-mail, or in-person.
Basic knowledge in lending and the real estate industry.
Excellent written and verbal communication.
Strong attention to detail. Ability to handle multiple tasks with frequent interruptions.
Knowledge of basic accounting processes and procedures. Basic computer skills including MS Office.
Associate’s degree in billing, coding, business, finance or related field required; equivalent work experience may be substituted for education 2 to 4 years of experience required.
Calls, customer Service, Claims, Collection, Payment, Billing