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ILLUMINATION FOUNDATION
Bethesda, MD, United States
Location field must contain 'city, state' or a zip code to perform a radius search (e.g., Denver, CO or 46122 ). City and state must be separated by a comma followed by a space (e.g., Houston, TX ) ILLUMINATION FOUNDATION Claims Specialist in Santa Ana , California “Every person deserves compassion, dignity, and the safety of a plac
Job Source: ILLUMINATION FOUNDATIONZurich NA
Bethesda, MD, United States
Location field must contain 'city, state' or a zip code to perform a radius search (e.g., Denver, CO or 46122 ). City and state must be separated by a comma followed by a space (e.g., Houston, TX ) Auto Litigation Claims Specialist 113285 Zurich is currently seeking an Auto Litigation Claims Specialist II. At Zurich North America Claims, we und
Job Source: Zurich NASocial Security Administration
Silver Spring
Summary LOCATION: This position is located in the Silver Spring MD Field Office at 10230 New Hampshire Ave, Silver Spring MD 20903. TOUR OF DUTY: Flextime | Full-time | Alternate work schedules may be available. TYPE OF POSITION: This is a permanent position. Responsibilities The position description number for this position is 5E2400. A summary of
Job Source: Social Security AdministrationHealthcare Legal Solutions LLC
Washington, DC, United States
Job Description Job Description Healthcare Legal Solutions LLC is currently seeking an experienced Healthcare Claims Analyst to join our team in Washington DC. About Us: Healthcare Legal Solutions, LLC, is a healthcare collections firm that provides denial management, consulting, and corporate collections services to hospitals and health syst
Job Source: Healthcare Legal Solutions LLCHealthcare Legal Solutions LLC
Washington
Job Description Job Description Healthcare Legal Solutions LLC is currently seeking an experienced Healthcare Claims Analyst to join our team in Washington DC. About Us: Healthcare Legal Solutions, LLC, is a healthcare collections firm that provides denial management, consulting, and corporate collections services to hospitals and health syst
Job Source: Healthcare Legal Solutions LLCSelective Insurance
Washington, DC, United States
Description At Selective, we don't just insure uniquely, we employ uniqueness. Our Business Selective is a midsized U.S. domestic property and casualty insurance company with a history of strong, consistent financial performance for nearly 100 years.Selective's unique position as both a leading insurance group and an employer of choice is rec
Job Source: Selective InsuranceLincoln Financial Group
Washington
**Alternate Locations:** Work from Home; Bakersfield, CA (California); Boise, ID (Idaho); Denver, CO (Colorado); Glendale, CA (California); Greenwood Village, CO (Colorado); Irvine, CA (California); La Jolla, CA (California); Los Angeles, CA (California); Palm Desert, CA (California); Phoenix, AZ (Arizona); Portland, OR (Oregon); Provo-Orem, UT (Ut
Job Source: Lincoln Financial GroupCorVel Enterprise Comp, Inc.
Rockville
Job Description Job Description The Liability Claims Manager is participates in formulating and administering company best practices as well as developing long-range goals and objectives, analyzing costs, activities and operations, supporting the goals of claims department and of CorVel. This is a hybrid role. ESSENTIAL FUNCTIONS AND RESPONSIBIL
Job Source: CorVel Enterprise Comp, Inc.Silver Spring
Job Description Job Description CCI Health Services’ mission is to deliver high quality, accessible care to our community members, leading the way to a more equitable health care system for everyone.
Position Summary
CCI is seeking a Claims Specialist to serve as a financial resource in support of the clinical services provided. The Claims Specialist will assure that services are promptly and accurately processed in accordance with all applicable Federal, State, and local regulations and guidelines, that claims are adjudicated in a timely manner, and customer’s needs are met in a professional and courteous manner.
Key Functions & Responsibilities
Review and analyze encounters to ensure completeness, accuracy, adherence to all system edits (both core system and clearinghouse), and in compliance with all State, Federal, and/or contracted payer rules, terms, regulations, and guidelines.
Ensures claims are processed in a timely manner, adhering to a standard of claim submission within five (5) days from the date of service, and follows up with individual and/or providers in those situations exceeding five (5) days from the date of service.
Ensures any claims which are rejected by the clearinghouse, or the payer are addressed, resolved, and resubmitted with corrections.
Addresses all denials from individual insurers in a timely, efficient, and collaborative manner, communicating with the health centers and support center personnel to effectively challenge denials and reverse the denial decision.
Files appeal of denials in a timely and professional manner within the specified timeframes as published by regulations, rules, or guidelines of the payer.
Responds in a timely and professional manner to all patient, insurance, or professional inquiries and concerns.
Exhibit and apply knowledge of Commercial Indemnity guidelines in the processing, adjudication, and payment of claims.
Maintain current understanding and application of all Medicare and state Medicaid compliance requirements regarding avoidance of allegations of fraudulent or false claims.
Maintain productive and efficient communication with third-party payers which achieves expeditious claim adjudication and payment.
Maintains consistent and timely follow-up with third-party payers and patients (as applicable) in unpaid claims beyond the expected payment date, ensuring each account is clearly and concisely documented with all efforts to expedite payment.
Utilize online claim status applications in an effective and efficient manner in managing account follow-up.
Make necessary adjustments to account balances with prior authorization from management to ensure the integrity of the account balance.
Checks each insurance payment to ensure accuracy and compliance with contract discount terms.
Evaluates patient financial status and established budget payment plans or eligibility for Sliding Scale consideration.
Must ensure open and constructive coordination with health center personnel in maintaining accuracy in data elements and processing crucial to effective claims processing and account resolution.
Must ensure adherence with all HIPAA Regulations and Compliance Regulations ensuring the protection of PHI (Patient Health Information).
Minimum Qualifications
Minimum High School diploma, an AA or BS degree preferred or commensurate experience.
Must have at least 2 years of relevant work experience in a Physician Practice/Hospital-based Physician Center/FQHC setting or can have an equivalent combination of training and experience to perform functions outlined for this position.
Strong attention to detail.
Must be familiar with hospital and or physician coding.
Strong customer service skills - bi-lingual (English/Spanish) is a plus.
Must be assertive and goal oriented.
Familiarity with computerized systems is required.
Must be a willing participant in ongoing educational activities and a contributing participant in staff meetings.
Working on-site is an essential duty for the job.
Why Work at CCI? Extensive benefits plan
Generous PTO Plan
403B Retirement Plan + Employer match up to 4%
Tuition Reimbursement
Continuing education assistance; can be used toward obtaining certifications, renewal of certifications, or possible conference attendance.
Our providers are insured for malpractice under the Federal Tort Claims Act.
** CCI Health Services is an Equal Opportunity Employer **
Founded in 1972, CCI Health Services is a diverse and inclusive workplace grounded in community. Located in the Washington, DC Metro Area, each year CCI cares for more than 60,000 individuals in Montgomery and Prince George’s Counties. As a non-profit, CCI is committed to improving health equity through the provision of affordable primary care for all, across all stages of life. Visit ccicares.org for more information.
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Email Alert for Claims Specialist jobs in Silver Spring
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