Claims Specialist - Administrative Services East - Full Time

GENERAL RESPONSIBILITIES:

1.Provides professional and courteous service to all "customers" of the Business Office. Customers include all patients of Ogden Clinic and its affiliates, administration, employees, co-workers, insurance company representatives, and all other vendor representatives.

2.Accountable for meeting behavioral expectations, and supporting the dignity of all persons. Also, responsible for the stewardship of resources.

3.Ensures applicable regulatory requirements are complied with and follows guidelines that maintain safety for oneself, patients, visitors, and co-workers.

4.Responsible to study and follow all clinic Policy and Procedures.

5.Responsible to maintain an adequate level of productivity as defined with the Business Office Manager.

ESSENTIAL JOB FUNCTIONS:

1.Print, review and distribute all paper claims.

2.Work "unknown Insurance" rejections by verifying insurance information, updating the system and resubmitting claims.

3.Process and correct all rejected claims through Waystar. Update totals in the Daily Balancing spreadsheet.

4.Assign mail to claims specialists daily.

5.Approve statement files daily.

6.Download/Save 835 files daily.

7.Other duties as assigned by the Business Office Manager.

OTHER DUTIES:

1.Assists with special projects as assigned.

2.Maintains confidentiality of patient records and employee/co-worker information.

3.Responsible to study and utilize eClinicalWorks and Excel software system to improve use and knowledge of the system's capabilities.

4.Follow all Compliance, HIPAA and OSHA regulations.

QUALIFICATIONS:

1.EDUCATION: High School Diploma or general education degree (GED).

2.LANGUAGE SKILLS: Ability to read and interpret documents such as safety rules, operating and maintenance instructions, procedure manuals, EOB's, and Insurance Claims forms.

Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of the organization.

3.Must be able to manage multiple tasks simultaneously.

4.Computer knowledge with experience in basic word processing and spreadsheet programs are required.

5.General office equipment and procedure knowledge helpful.

CHARACTERISTICS:

1.Must maintain a positive "can-do" attitude.

2.Must be willing to effectively participate as a team member with the Business Office and practices.

3.Must be committed to the protection of confidential information, records, and/or reports.

4.Must have the ability to communicate effectively in a professional and courteous manner.

5.Must have good organizational skills.

ENVIRONMENTAL FACTORS:

1.Requires prolonged sitting.

2.Requires some bending, stooping, lifting, and stretching for files and supplies.

3.Requires manual dexterity sufficient to operate a keyboard and other office equipment.

4.Must possess all physical abilities necessary to perform the job.

5.Noise Level is Moderate with the constant noise of business office computers, printers, telephones, etc.

DISCLAIMER CLAUSE:

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills, efforts, or working conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.