Claims Management Specialist

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JOB SUMMARY:

Must have the ability to communicate both verbally and in writing. Mainframe computer skills, basic accounting, detailed clerical skills and good customer relation skills are required. Candidate must manage accounts according to third party payer rules and regulations. Candidate must posses an understanding of medical and third party payer terminology.

REPORTS TO:

JOB SPECIFIC RESPONSIBILITIES:

Process claim production queues appropriately

Review claim production reports and claim production edit reports

Understand payer specific requirements for electronic and paper claim submission

Document accurately on visits in IDX to convey the billing issue for correction.

Take corrective action when errors are noted on claims

Review payer confirmation reports to ensure all transmitted claims were received by payers

Review paper claims to ensure that affected claims cannot be submitted electronically

Work hold bills assigned by supervisor

Communicates effectively with supervisor and staff to reduce the number of recurring claim errors

Audits the payer table within Click-On to ensure that claims are submitted to the correct payers

EDUCATION AND EXPERIENCE:

High school graduate or equivalent required.

REQUIRED LICENSURES/CERTIFICATIONS/REGISTRATIONS:

None required.

SKILLS AND ABILITIES:

Highly technical. Troubleshooting skills are required.

INTERACTION WITH OTHER DEPARTMENTS AND OTHER RELATIONSHIPS:

This position requires interaction with most other UMC Health System departments, medical staff, and technical personnel at Texas Tech University Health Sciences Center and Physician Network Services. This position also deals directly with technical support analysts employed by contracted hardware and software vendors.

PHYSICAL CAPABILITIES:

Work is of medium demand. Walking, sitting and standing most of the time while on-duty. Occasional lifting of equipment is required. Adequate hand/eye coordination and fine motor skills required for typing. Talking and hearing is essential in dealing with co-workers and customers.

ENVIRONMENTAL/

WORKING CONDITIONS:

Works in a well-lighted, heated and ventilated building.

DIRECT REPORTS:

UMC Health System provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment on the basis of race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
* Request for accommodations in the hire process should be directed to UMC Human Resources.
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