Medical Claims Clearinghouse Specialist

POSITION SUMMARY

Responsible for the accurate entry of physician and ancillary charges into Claims Clearinghouse module.

RESPONSIBILITIES AND ACCOUNTABILITIES

Claims:

Submits provider claims to clearinghouse on a daily basis. Correct claims errors for clean claim submission on day of submission. Communicate to Supervisors and other team members to assist in claim error correction. Document the number of claims received and rejected on the daily claim's submission log Correspond to Supervisors to improve workflows to prevent claim errors. Create reports with Supervisor to track trends within the Clearinghouse. Keeps up on changes in medical billing and coding Assist with special accounts receivable projects

Customer Service and Communications:

Communicates with patients, insurance carriers and other outside entities in a professional manner. Identifies solutions and responds professionally to patient concerns, i.e., pleasant tone of voice, courteous language, etc. Uses appropriate grammar and demonstrates tact and diplomacy in patient interactions, by phone and in person. Diffuses negative situations with patients and maintains a pleasant and professional tone during stressful circumstances and heavy workload. Communicates with staff members in a professional, pleasant manner; Shares information relevant to work, no gossiping or disparaging remarks, accepts work without complaint or provides reasons why assignment is unmanageable, asks and answers questions related to improving department performance.

TEAMWORK

Teamwork:

Willingly provides coverage, volunteers assistance, and maintains workflows within department as needed without direct instruction/supervision. Works cooperatively and refrains from participating in negative conversations. Shares knowledge and insights with co-workers in a constructive manner. Works to solve problems and address conflicts with appropriate person directly before involving leadership or uninvolved peers. Is considerate of others in the work environment with regard to taking breaks or meal periods, use of computer and phone, noise level in the department, etc.

POLICIES AND PROCEDURES

Policies and Procedures Knows and complies with policies and procedures as enumerated in the Orthopedic One Employee Handbook and policies and procedures documents. Provides assistance and support to leadership in implementing policies and procedures as necessary. Actively participates in training, and conducting day to day work activity by adhering to all policies and procedures as enumerated in compliance and risk management programs.

QUALIFICATIONS

Education, Experience, Certification and Licensure Requirements:

A high school diploma/GED required. A minimum of five years of previous medical billing experience preferred. Ideal candidate will have experience in managing claims through clearinghouse.