Derex Technologies Inc is hiring a Senior Insurance Claims Specialist to manage the complete revenue cycle for patient account balances. You will be responsible for accurate claim submission, compliance with billing regulations, and denial management to ensure financial viability while serving as a key resource for departmental processes.
What You'll Do
- Submit accurate and timely claims to third-party payers.
- Resolve claim edits and account errors prior to submission.
- Adhere to procedures for follow-up with payers to ensure collections.
- Gather statistics, complete reports, and perform other scheduled duties.
- Organize daily tasks to achieve optimal productivity and efficiency.
- Comply with HIPAA regulations regarding PHI and claim processes.
- Contact third-party payers to resolve unpaid claims.
- Utilize payer portals and websites to verify claim status and conduct follow-up.
- Assist Patient Access and Care Management with denials investigation and resolution.
- Access and utilize all necessary computer software, applications, and equipment.
- Participate in required educational programs.
- Attend department meetings, teleconferences, and webcasts as necessary.
- Research and process mail returns and claims rejected by payers.
- Reconcile billing account transactions to ensure accuracy.
- Process billing and follow-up transactions accurately and timely.
- Develop and maintain knowledge of federal, state, and local hospital billing regulations.
- Monitor accounts to facilitate timely follow-up and maximize cash receipts.
- Maintain work queue volumes and productivity within established guidelines.
- Provide excellent customer service to patients, visitors, and employees.
- Participate in performance improvement initiatives.
- Work with leadership to develop and exceed annual goals.
- Maintain confidentiality according to policy.
- Communicate workflow problems to management promptly.
- Serve as a resource for co-worker process questions and concerns.
- Work with the Hospital Billing Trainer to identify training opportunities.
- Serve as a Super User for key billing software.
- Exceed productivity measures as demonstrated by performance dashboards.
- Assist in the annual review of departmental policies and procedures.
What We're Looking For
- High School Graduate or equivalent.
- Ability to obtain Certified Revenue Cycle Representative (CRCR) Certification from AAHAM or HFMA within 90 days of hire.
- Commitment to complete eight hours of revenue cycle continuing education annually.
- Three (3) years of medical billing or medical office experience.
Nice to Have
- Three (3) years of medical billing/medical office experience, preferably related to claims billing and insurance follow-up.
Technical Stack
- Quadax
- FISS
- Epic
Team & Environment
You will work with leadership and other team members to achieve best-in-class revenue cycle operations.
Work Mode
This is a fully remote position.
Derex Technologies Inc is an equal opportunity employer.
