Are you a skilled communicator with problem-solving abilities and an analytical mindset?
St. Joseph's Villa is seeking an Insurance Claims Specialist with a minimum of 3 years of experience in Medical/Medicaid/Private Insurance billing.
Essential Job Functions:
Perform compliance checks in the client database to track eligibility, authorizations, and utilization of insured services.
Verify, compile, and input data into reports to monitor ongoing processes and identify areas for improvement.
Respond to unpaid or denied bills through direct coordination with designated service and office staff.
Act as the primary liaison between services and finance to resolve unpaid or denied bills.
Coordinate and track required responses from services to the external billing agency for timely information on un-submitted, unpaid, and denied claims.
Assist the Finance Office in researching complex denied claims.
Gather information from various sources, including the client database, internal and external reports, and service management, to fulfill assigned responsibilities.
Maintain and regularly update internal reports for insurance billing based on authorization utilization.
Collaborate with the Finance Office to submit, exchange, and reconcile insurance billing reports.
Provide the Finance Office with necessary information for billing submission and re-submission upon request.
Prepare regular reports for internal and external entities as requested or according to a defined schedule.
Maintain statistical and evaluative data and prepare or review regular reports as required.
Evaluate work processes and methods, identify gaps, submit recommendations for continuous quality improvement, and implement approved changes.
Reconcile records and reports on a routine basis, depending on the type of information.
Required Qualifications:
- Associate degree required in a related field. Bachelor's degree preferred.
- Knowledge of credentialing processes, billing requirements for third-party insurance payers, and automated billing systems is a must.