Claims Specialist Hybrid- FlexStaff (TEMP)

FlexStaff is seeking a Claims Specialist to support department operations related to provider communication, pending claim review, reporting, auditing, and oversight activities. 

Schedule: Monday-Friday 8:30 am-5:30 pm (1 hour lunch) Hybrid Wednesday and Friday in the office. 

Responsibilities:

• Reviews and investigates claims to be adjudicated by the TPA, including the application of contractual provisions in accordance with provider contracts and authorizations
• Compiles claim reports for adjustments resulting from external providers, vendors, and internal inquiries in a timely manner
• Investigates suspense conditions to determine if the system or procedural changes would enhance claim workflow
• Communicates and follows up with a variety of internal and external sources, including but not limited to providers, members, attorneys, regulatory agencies, and other carriers on any claim related matters
• Analyzes patient and medical information to identify COB, Worker's Compensation, No-Fault, and Subrogation conditions
• Validates DRG grouping and (re)pricing outcomes presented by the claims processing vendor
• Attends JOC meetings with providers as appropriate to assist in communicating proper billing procedures and to explain company coverage guidelines
• Assists TPA with provider compensation configuration by creating and testing compensation grids used for reimbursement and claims processing
• Ensures that refund checks are logged and processed, enabling expedited credit of monies returned
• Analyzes check return/refunds volumes and trends to determine root causes. Proposes workflow changes to correct and enhance claim processes to prevent returned checks/refunds
• Generates routine daily, monthly and quarterly reports used for managing process timeframes and vendor productivity, ensuring compliance with all regulatory requirements and contractual vendor SLAs
• Enters charges, payments, and adjustments into department computer system and/or posts to manual records. Reviews batches to ensure accuracy.
• Verifies patient demographics, third-party coverage, codes, allowances, etc.
• Prepares bills and/or correspondence to third-party carriers and/or patients for reimbursement for services rendered.  
• Attends to telephone inquiries, audits and mail applicable to accounts receivable.  Sets up financial agreements with patients, as required.
• Keeps billing files organized. Maintains daily, weekly and monthly records of fees collected.
• Performs related duties as required.

Qualifications: 

• Bachelor's degree. Certified Professional Coder (a plus)
• Eight or more years of insurance experience within a healthcare or managed care setting (preferred)
• Prior third party insurance billing experience, required.
• Knowledge of medical terminology, preferred.
• Ability to communicate effectively.

  *Additional Salary Detail The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).