Healthcare Claims Specialist

We’re searching for Claims Specialists for our Arkansas area!

Details:

• Fully Remote
• 3 month contract with possibility of extension/hire
• Pay: $18-$22 hourly
• Monday-Friday 8am-5PM CST
• MUST be able to work in CST time
• Medical claims processing experience – AMISYS strongly preferred
• This role may involve phone work such communicating with providers and members when processing claims.

Summary

The Claims Specialist resolves medical claims that are not automatically adjudicated by the claims processing system in a timely and accurate manner according to divisional standards of quality and productivity. Resolution may include additional investigation or communication in order to obtain necessary information to complete the claim.

Responsibilities

• Claims processing involves the actions required to pay or deny pended claims (those which did not auto-adjudicate), including entering data into the system; reviewing and interpreting contract benefits; conducting edit and audit resolution; determining benefit eligibility.
• Identifying and researching processing issues through systems and manuals; routing claims to other areas; consulting internal staff and medical providers; generating correspondence; and completing forms to obtain necessary information.
• Demonstrating knowledge of and possessing the ability to access all relevant computer systems and screens in order to process claims accurately; staying current with continually changing processing procedures, benefits, and system modifications; being knowledgeable of and able to meet corporate and national (MTM) standards while maintaining acceptable performance levels based on established departmental standards for productivity and quality; and showing familiarity with corporate and professional manuals and guidebooks, including the company processing manual and ICD, CPT, and HCPS codebooks.

Requirements:

• Review and process insurance claims submitted by healthcare providers, which could include hospitals, doctors, laboratories, and other medical facilities.
• The Claim Specialist will ensure that claims are accurate, complete, and compliant with insurance policies and regulatory guidelines.
• Verify the accuracy of information provided in the claim, such as patient details, medical services provided, diagnosis codes, and billing codes.
• Adjudicating claims by determining whether they meet the criteria for coverage as outlined in the policy.
• Analyze supporting documents, such as medical records, treatment plans, and invoices, to ensure that the services billed match the services rendered and that they are medically necessary.
• Participate in quality assurance initiatives to ensure that claims are processed accurately and efficiently, minimizing errors, and maximizing customer satisfaction.

Minimum Job Requirements

• High School diploma or equivalent.
• Two (2) years of college coursework (48 semester hours) or other equivalent certification with an emphasis in anatomy, medical terminology, math, biology, or a related field
• One (1) year of related office experience such as claims processing, health insurance, or medical office.

If you're interested in learning more! Apply today!

Wollborg Michelson Recruiting does require all applicants to be able to provide proof that they are fully vaccinated from COVID prior to their start date, unless otherwise prohibited by law. Wollborg Michelson Recruiting is an Equal Opportunity Employer and prohibits discrimination of any kind. We ensure job offers are made based of one’s employment experience, skills, and qualifications, regardless of race, gender, ethnic origin, or any other classification protected by law. All applicants must furnish proper identification to prove their legal right to work in the US upon a job offer. We participate in E-Verify to confirm one’s right to work in the US. Wollborg Michelson Recruiting does not provide sponsorship for an employment-based visa status.