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Claims Specialist
Job#: 06192013
Positions: 1
Posted: 08/22/2013
Job Type: Full Time
Location: Austin, TX
Department: 60-Client Services
Category: Billing Services
Salary: Hourly
Benefits: Full Benefits
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Job Description

Summary: The role of a Claim Specialist in the Revenue Cycle Management department is to create and submit accurate and compliant claims to the appropriate parties on behalf of our clients. 


Essential Duties and Responsibilities: Please note that other duties may be assigned by your supervisor.  

  • Build & review claims
  • Submit claims to insurance carriers
  • Work all claim rejections
  • Communicate with clients regarding coding/invoicing  issues
  • Participate in monthly close-out processes
  • Participate in client meetings
  • Answer patient, client, or insurance carrier questions regarding claims
  • Maintain the strictest confidentiality in accordance with all HIPAA guidelines/regulations
  • Stay abreast of code changes, updates to reimbursement guidelines, and coverage policies

Qualifications:   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 including computer skills/level.

  • Working knowledge of healthcare code sets
  • Working knowledge of clean claim practices including bundling rules and claim edits
  • Understanding of the complete healthcare revenue cycle
  • Basic understanding of provider contracts and credentialing
  • Proficient in Microsoft Outlook, Word, Excel
  • Organized and detail-oriented


Education and/or Experience or both: Previous experience in a healthcare billing capacity required.  Previous experience with electronic health records/practice management system desired.


Certificates / Licenses / Registrations: None required, coding certificates desirable (CPC, CCS-P, etc.)

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