Job Opening

Claims Specialist

The Claims Specialist role focuses on processing charges submitted by the client office, reviewing any charges that cannot be processed and notifying the Team Lead of Billing of any charge issues.  Additionally, the Claims Specialist will monitor and correct ZirMed rejections to ensure accurate and timely submission of claims for payment, work deposit queries, and process the monthly patient statements.

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Claims Specialist

ESSENTIAL DUTIES AND RESPONSIBILITIES

  • Process charges to completed and transmitted claim status.
  • Monitor paper claims that are submitted with notes for any errors.
  • Notify the Billing Manager if a client (DB) has no charges for 2 consecutive days or more.
  • Work ZirMed rejections at least 3 times per week.
  • Submit payer enrollments for ERA or EFT if not done while in implementation.
  • Perform name matching in ZirMed.
  • Work with the client office to resolve incomplete charges or missing information required to submit a complete claim.
  • Submits secondary or tertiary billing with documentation as needed.
  • Work and resolve system tasks within 2 business days.
  • Work documentation change tasks within 1 business day.
  • Work deposit queries within 2 business days.
  • Pull in ERA’s for assigned clients.
  • Once all patient unapplied funds have been worked, run monthly patient statements for release; review for accuracy before sending.
  • Answer phone calls from clients or patients and resolve or triage to another resource.

SECONDARY DUTIES AND RESPONSIBILITIES

  • Be passionate about problem solving and identifying errors.
  • May be assigned other duties related to billing or processing of claims.

EXPERIENCE AND EDUCATION

  • 2 years previous experience in insurance, medical billing, or healthcare operations to have obtained a deep knowledge of medical terminology.
  • Strong knowledge of medical billing including commercial payers, Medicare, Medicaid, workers’ compensation and patient responsibility is highly desirable.

SKILLS AND ABILITIES

  • Must be a role model of Clinicient’s Core Values: Be Honest and Transparent; Coach More, Shoot Less; Deliver Exceptional Results; Enjoy the Journey; Fail Fast, Succeed Faster; and Find a Better Way.
  • Knowledge of CPT and ICD coding.
  • Ability to achieve strong production metrics but attention to detail with minimal errors.
  • Strong oral and written communication skills; ability to resolve issues from patient or client phone calls.
  • Proficiency in the use of computers and MS office suite (excel and word).
  • Ability to adapt to a changing and flexible work environment.
  • Comfortable working with minimal supervision and in a team environment.

WORK ENVIRONMENT

This position is performed primarily in an office environment. Significant portions of the job require extended sedentary periods, constant work with computers (including extended period of keyboarding), and repetitive motion of hands and wrists. Some limited travel to client locations may be required.

Clinicient offers a competitive benefits package with robust medical benefits, $100 monthly transportation reimbursement, monthly All-Hands meetings, company hosted happy hours and special events. Our offices are located in the heart of downtown Portland, Oregon, close to Pioneer Square, Food Carts and TriMet bus and MAX stops.

Clinicient is an equal opportunity employer and promotes a drug-free workplace.

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