Claims Specialist Position Available In New Hanover, North Carolina
Tallo's Job Summary: The Claims Specialist position at EMPOWER HEALTH GROUP LLC in Wilmington, NC offers a full-time role with a salary of $45,000 a year. Qualifications include medical coding knowledge, a high school diploma or GED, and previous experience in claims follow-up. Responsibilities involve daily claims follow-up, resolving issues, and communicating with the billing department to ensure accurate payments and timely processing. Employee benefits include health insurance, dental insurance, 401(k), vision insurance, life insurance, and opportunities for advancement.
Job Description
Claims Specialist
EMPOWER HEALTH GROUP LLC – 5.0
Wilmington, NC Job Details Full-time $45,000 a year 9 hours ago Benefits Health insurance Dental insurance 401(k) Vision insurance Opportunities for advancement Life insurance Referral program Qualifications Medical coding Mid-level High school diploma or GED Medical billing Associate’s degree Full Job Description SUMMARY The Claims Specialist will have familiarity with insurance billing rules, regulations, and procedures for substance abuse treatment. Works closely with the billing department on claims activity to ensure issues are resolved quickly and payments received. Provides updates regularly to the leadership team and billing department. Participates in billing meetings providing key data of trends for claims.
JOB FUNCTIONS
Performs daily claims follow-up, ensuring that accurate payments are received in a timely manner. Identifies barriers to claims and communicates necessary adjustments needed. Reviews all newly submitted claims looking for denied and rejected claims daily and weekly to resolve all issues and resubmit claims back for payment. Accurately utilize billing documents and system while providing the billing department with the necessary updates to correct and rebill. Reviews data on insurance policies to ensure accurate claim processing and payment. Ensure corrected claims are submitted right away. Prepare materials for submission to insurance companies as requested. Ensure unprocessed claims are processed and payment received. Develop and submit appeals information, including supporting documentation as needed. Communicates frequently with leaders and the billing department to keep claims processing timely and effectively. Must have the ability to organize daily workflow to ensure billing data, trends, and proper follow up is managed timely. Works closely with the billing company on aged client accounts with long term outstanding balances to identify resolution and any documentation needed. Performs bi-weekly reverification of insurance for current census. Works closely with billing to obtain Assignment of Release (AOR) and Continuation of Benefits (COB) information when needed.
BENEFITS
(if eligible): Employee Referral Program Employee Assistant Program Health Insurance Dental Insurance Vision Insurance Life Insurance 401(k) Plan Opportunities for advancement
EDUCATION AND EXPERIENCE
High School diploma or equivalent, associate’s degree preferred Previous experience in claims follow up required Knowledge of medical billing and coding related to SUD services
