Insurance Claims and Denials Specialist

Essential Functions:

• Manage and resolve outstanding insurance claims based on payer assigned.
• Review and understand EOBs and COBs
• Investigate chart notes to understand coding of claim or possible reasons for denials
• Execute and coordinate the filing of claims, corrections, and voids across multiple payers.
• Coordinate and manage submission of claim denials through dispute, denials, or reconsideration.
• Comfortability navigating through various insurance portals to locate claims, EOBs, reconsideration submissions and records.
• Comfortability with ICD 10 Codes
• Analyze and identify denial trends across multiple payers to determine best practice to avoid future denials.

Knowledge Skills and Abilities:

• Outstanding customer service skills- written and verbal
• Demonstrates proficiency in medical insurance, automated billing systems and medical software.
• Demonstrates good judgment in handling situations not covered by written or verbal instruction and seeks guidance as needed.
• Perform work within appropriate time frame, accurately and in a timely manner in periods of increased workload.
• Ability to recognize and resolve billing problems.

Required Education and Experience:

• At least 2 years previous medical billing experience, preferred in OBGYN
• Previous customer service experience
• Previous experience with high patient volume.
• High School diploma or equivalent.