Claim Status Specialist
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POST DATE 8/10/2016
END DATE 10/21/2016
JOB DESCRIPTIONJob Code: 25537-123311
Parallon believes that organizations that continuously learn and improve will thrive. That's why, after more than a decade, Parallon remains dedicated to helping hospitals and hospital systems operate knowledgeably, intelligently, effectively and efficiently in the rapidly evolving healthcare marketplace, today and in the future.
As one of the healthcare industry's leading providers of business and operational services, Parallon is uniquely equipped to provide a broad spectrum of customized services in the areas of revenue cycle, purchasing, supply chain, technology, workforce management and consulting.
Parallon's purpose is simple. We serve and enable those who care for and improve human life in their communities.
JOB TITLE: Claim Status Specialist
GENERAL SUMMARY OF DUTIES: Status and follow up with payers, vendors, and clearinghouse on open insurance claims and balances which may include re-filing primary and secondary claims. Enters appropriate notes and takes appropriate actions in the system to route claims to appropriate departments for processing.
SUPERVISOR: Claim Status Manager
DUTIES INCLUDE BUT ARE NOT LIMITED TO:
Status and follows up with payers, vendors and clearinghouse on open insurance claims and balances.
Identifies and investigates claim formatting issues and escalates to applicable department.
File and/or re-file primary and secondary claims.
Perform web research and update patient accounts as necessary
Identify potential claim issues and escalate to applicable department.
Follow policies and procedures
Meet productivity and quality benchmarks as set by the department.
Documents findings and actions taken into the appropriate system.
Escalates claim issues to Team Lead, Manager or department based on the nature of the issue.
Maintains and protects confidentiality with regard to all aspects of patient care information.
Understands and adheres to the Shared Services for Physicians patient balance collection philosophies.
Practices and adheres to the Code of Conduct philosophy and Mission and Value Statement .
Performs other duties as assigned.
KNOWLEDGE, SKILLS, & ABILITIES This position requires the following minimum requirements:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION and/or EXPERIENCE
High school diploma or general education degree (GED) required. Experience with Microsoft Office applications is helpful (Outlook, Word and Excel). Knowledge of medical terminology, ICD9 & CPT4 coding preferred.
The ability to apply common sense understanding to carry out detailed written or oral instructions and to communicate effectively, both orally and in writing.
Ability to manage own time and work assignments effectively while following policies and procedures.
PHYSICAL DEMANDS/ WORKING CONDITIONS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Staff must remain flexible and available to provide staffing assistance for any/all disaster or emergency situations. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee is occasionally required to stand and walk. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, color vision, and ability to adjust focus. Work may be stressful at times. Contact may involve dealing with angry or upset people.
Last Edited: 08/09/2016