Patient Financial Services Reimbursement Specialist I

Claim Submission Specialist

Maintains accurate and timely claim submission for designated groups of accounts by payer. Insures that all claims are compliant with State and Federal billing regulations and contractual obligations. Collects cash from third party payers and patients. Expedites inquiries by mail or phone as related to the designated group of accounts. Insures accurate and timely application of cash received. Processes statements to insure an effective billing system.

Responsibilities:

• Accurate, timely and compliant claim submission.
• Confirmation of electronic and hard-copy billing of any delinquent claims. Re-billing & follow-up of all delinquent claims.
• Responds to all patient and payer inquiries, denials, correspondence & telephone inquires.
• Maintains all reports (contract management) files and records as needed; i.e., medical records, referrals, pre-certification letters etc.
• Advises other areas of updated insurance information and claim denials; i.e., registration.
• Follows through with education of rules and regulations in the managed care system, as well as, State & Federal guidelines.
• Adjusts account balances to specific account needs; i.e., capitated labs.
• Maintains Contract Management reporting (i.e., payment errors, carve out billings) and updates any information as needed or requested by supervisor.
• Applies cash received to appropriate accounts. Refunds all overpayments as necessary.
• Maintains departmental policies and procedures.
• Adheres to all policies and procedures related to compliance with all federal & state billing & collection regulations & third party contractual obligations.
• Fulfills all compliance responsibilities related to the position.

Other Information: Required: HSD or equivalent. Data entry. Customer service experience required. Minimum Experience: six months. Desired: Experience in billing and collections or Medical Office/Healthcare experience preferred.

Company: Nuvance Health Org Unit: 1785 Department: Patient Accounting Exempt: No Salary Range: $19.00 - $25.00 Hourly

We are an equal opportunity employer. Qualified applicants are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other classification protected under applicable Federal, State or Local law. We will endeavor to make a reasonable accommodation to the known physical or mental limitations of a qualified applicant with a disability unless the accommodation would impose an undue hardship on the operation or our business. If you believe you require such assistance to complete this form or to participate in an interview, please contact Human Resources.