A Claims Adjuster or Specialist investigates and evaluates insurance claims. Specializes in a particular type of insurance. Inspects property damage, including damage to homes, buildings and cars; reviews claims after they are submitted; may authorize or deny payment for claims. May work directly for insurers or on behalf of claimants.
Medicare Claims Resolution Specialist Starting at $17.50/hr but flexible for experienced candidates Do you enjoy puzzles and research? Are you results-oriented? If so, our Claims Resolution Specialist position may be a phenomenal career for you within Select Medical! Our dynamic team has the responsibility of resolving outstanding insurance claims so that our patients are not impacted. We offer an exceptional employee experience, full-time hours, full benefits, paid training, and advancement opportunities. Our team offers flexible, first shift, Monday through Friday schedules. This would include two fifteen minute breaks and one half-hour lunch. We allow for casual work attire, jeans are our norm!
Responsibilities:
Investigate and follow-up on all open balances for accounts that have received a payment or denial, or that are greater than 30 days from billing. Contact responsible party to establish reason for non-payment document in system all verbal and written communication relative to open account balance, and institute timely follow-up with responsible party as a result of last contact to assure progress in resolving account with payment. Maintain consistent, productive, and timely follow-up, as often as is needed to collect on the account. Time between account follow up is not to exceed 30 days. Maintain a productivity of 20 to 25 accounts per day. This is subject to change based on volume changes and operational needs. Make outgoing calls to patients, insurance companies and attorneys regarding claim status in order to reduce both outstanding receivables. Regularly communicate with hospital staff and department management on any accounts receivable issues/problematic payor trends. Identify and resolve issues impacting the timely collection of open receivables. As necessary, request account adjustments as identified via write off requests and refund requests. Notify database operations of changes or additions to specific payor, plan, contract, address, or other pertinent information as necessary. Meet the expectations and goals for productivity and collections targets as set forth by management. Performs other duties or special projects as assigned.
Qualifications:
Required:
High School Diploma or Equivalent One year of experience within a medical billing, medical collecting or claims processing role. Private and commercial claims collection experience (ideally provider side)
Medicare and Medicaid Preferred:
Computer Skills Microsoft Office:
Outlook Excel Ability to work with multiple programs simultaneously. Good interpersonal, oral and written communication skills. Previous experience in metrics based role, where production/quality standards are upheld. Time management and organizational skills Proven experience with investigative research. Ability to work independently and as part of team to reach mutually established goals. Attention to detail Flexibility and being open to change This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management.
Additional Data:
Select Medical strives to provide our employees with a solid work-life balance, as we understand that happy employees have both fulfilling careers and fulfilling lives beyond our doors. An extensive and thorough paid orientation program. Paid Time Off (PTO) and Extended Illness Days (EID). Health, Dental, and Vision Insurance; Life insurance; Prescription coverage. A 401(k) retirement plan with company match.
No Required Weekends Working Conditions/Physical Demands:
Office Environment Sitting for extended periods of time Ability to lift weight up to 35 lbs. Equal Opportunity Employer/including Disabled/Veterans
