Claims Specialist
总体位置目的：负责为医生，实践人员和收入周期团队提供高级别的保险索赔解决方案的支持。起薪：每小时22-25美元责任基本工作职责：·积极开展开放保险索求以确保快速处理 · 工作老龄化报告以确保未偿还索赔已收到并正在与付款人进行处理 ·通过与保险专家合作改善索赔流动来主动确定和解决索赔处理问题 ·阅读和解释支付者对福利的解释以验证根据合同指导方针裁定索赔 · 提出诉讼和追踪被拒绝的保险要求 ·审查，识别和解决付款人拒绝的要求 · 提供给付款人需的额外信息以允许申请处理 · 解决电子请求拒绝的情况 · 在实践中，管理系统中，纠正并重新提交我们清算室停止的索赔 · 正确并重新提交由付款人清算室拒绝的索赔 •个人和专业责任：·有效地沟通和发展与医生和所有团队成员建立强有力的合作关系，通过合作和专业行为促进团队协作 ·创造一个鼓励信任，开放交流，创意思维和团队协作的环境 ·通过内部和外部培训机会以及继续教育提供承担个人职业增长责任 · 遵守并表现对园牙医政策，专业期望和服务卓越标准的承诺 · 以展现与园牙医和牙科学专家使命，视觉和价值观工具和技术一致的行为为榜样和代表组织：· 实践管理，牙科 EDI 经验和知识 · 声称和/或牙科熟悉 · 已证明系统能力和强大的 MS 办公技能 （优秀，访问和词）. · 与保险公司网站熟悉。·快速研究新系统和软件工具以及愿意采用技术来提高生产力 需要的技能/资格：·具有强大的沟通能力，与他人建立建设性和合作关系的能力，努力协作并表现出专业精神 · 高水平的解释各种付款人福利说明 ·了解福利指导方针协调
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Overview
Position Purpose:
Responsible for providing support to doctors, practices, and Revenue Cycle teams with high-level insurance claim issue resolution.
Starting Wage: $22-25 per hour
Responsibilities
Essential Job Duties:
- Proactively work open insurance claims to ensure prompt processing
- Work aging report to ensure unpaid claims have been received and are in process with payers
- Improve claim flow by working with Insurance Specialist to proactively identify and resolve claim handling issues
- Read and interpret payer explanation of benefits to verify claims adjudicated in accordance with contract guidelines
- Appeal and follow up on denied insurance claims as assigned
- Review, identify, and resolve payer denials
- Provide payers’ requested additional information to allow claim processing
- Resolve electronic claim rejections
- In practice management system, correct and resubmit claims stopped by our clearinghouse
- Correct and resubmit claims rejected by payer clearinghouse
- Personal and Professional Responsibilities:
- Effectively communicate and develop a strong working relationship with the Doctors and all Team Members and promote teamwork through cooperative and professional behaviors
- Create an environment which promotes trust, open communication, creative thinking, and team collaboration
- Assume responsibility for personal professional growth through internal and external training opportunities and continuing education offerings
- Follow and demonstrate commitment to the Park Dental policies, professional expectations, and Service Excellence Standards
- Serve as an example and representative of the organization by demonstrating behaviors consistent with Park Dental and The Dental Specialists Mission, Vision, and Values
Tools and Technology:
- Practice Management, dental EDI experience and knowledge
- Claims and/or dental familiarity
- Proven systems aptitude and strong MS Office skills (Excel, Access and Word).
- Familiarity with insurance company website
- A quick study of new systems and software tools and a willingness to embrace technology to improve productivity
Required Skills/Qualifications:
- Possess strong communication skills and the ability to develop constructive and cooperative working relationships with others, striving for collaboration and demonstrating professionalism
- High skill level of interpreting a variety of payers’ explanation of benefits
- Understands coordination of benefits guidelines in depth
- Ability to manage multiple activities simultaneously with minimal direction, while relying on experience and judgment to plan and accomplish goals
- Detail oriented and well-organized
- Self-motivated and the ability to work independently
- Able to effectively deal with multiple locations, variety of internal customers, and patient situations
Education and Knowledge:
- Minimum two-year associates degree, bachelor’s degree preferred
- Familiarity with Dental and Medical insurance claims
- Experience with verbal and written communication to healthcare professionals and patients
Work Schedule
Monday through Friday 8am-5pm (hours are flexible)
- Position is remote! Applicants must currently reside in Minnesota, Arizona, or Wisconsin to be considered for this role.*
Company Information
Benefits
Park Dental offers competitive compensation, and generous benefits package including medical, vision, dental, PTO, holiday pay, 401k matching, and continuing education opportunities.
Community
Park Dental values being involved in the community through volunteer events, such as Minnesota Dental Association's Give Kids a Smile Day, the American Heart Association Heart Walk, and Minnesota Mission of Mercy. Each practice participates in events in their local communities too!
About Park Dental
Since 1972, Park Dental has been owned and led by our doctors who are passionate about providing the best patient-centered care. New team members receive comprehensive training and one-on-one mentoring to set you up for success. Our practices offer welcoming environments for patients, and are equipped with state of the art technology.
"As a dental hygienist with Park Dental, we have the opportunity to engage patients in the process of improving and maintaining their oral health, which in turn leads to over-all health." -Berit Campbell, DH Mentor
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Park Dental is an equal opportunity employer.
Originally posted on Himalayas