SHP Claims Specialist

Description:

  • Continually seek to understand and act upon client needs, concerns and priorities on various types of claims including but not limited to: Health Insurance, Worker’s Compensation and Motor Vehicle Accident claims.
  • Utilize various client computer systems to obtain information required to process insurance claims and document all efforts performed on behalf of the client.
  • Identify the appropriate payer source and submit claims information to insurance companies according to specific payer requirements.
  • Contact insurance companies to resolve claim processing issues that are delaying reimbursement.
  • Contact patients to obtain insurance information.
  • Review medical bills for possible CPT/HCPCS coding issues.
  • Review Explanation of Benefit forms to identify underpayments and pursue underpaid line items.
  • Assist SHP’s attorneys with special client projects.

Requirements:

  • Ability to problem solve, prioritize duties and follow-through completely with assigned tasks.
  • Excellent communication skills – both written and verbal.
  • Above average analytical and critical thinking skills.
  • Good organizational and prioritization skills.
  • Intermediate understanding of medical billing form requirements (UB04 and CMS 1500).
  • Intermediate understanding of ICD-9, ICD-10, CPT and HCPCS coding rules and regulations.
  • Proficiency in Word and Excel.

 

Education:

  • High School Diploma or equivalent required. Some college coursework in Health/Business administration preferred.
  • 2-3 years’ medical claims and/or hospital collections experience preferred.

 

SHP is always looking for qualified individuals to join our team: if you are interested in joining our team, please contact our Human Resources Manager.