Claims Compliance Specialist - Xelerate, LLC
Plainfield, NJ 07060
About the Job
Are you someone who thrives with organization and precision? We are seeking a proactive and detail oriented individual to join our outpatient clinic.
As a Claims Specialist, you will play a crucial role in ensuring the smooth and efficient processing of insurance claims for outpatient mental health services. You will be responsible for submitting claims, following up on denials, and resolving issues with insurance companies. Your goal is to ensure timely and accurate claim submissions and payments while maintaining patient confidentiality and upholding our clinic’s standards.
Key Responsibilities:
- Accurately prepare, submit, and track insurance claims for outpatient mental health services.
- Review and correct claim errors, and resubmit denied claims promptly.
- Communicate effectively with insurance companies to resolve claim issues and discrepancies.
- Verify patient insurance coverage and update patient records accordingly.
- Maintain and manage detailed records of all submitted claims and related correspondence.
- Stay up-to-date with insurance guidelines, policies, and regulations.
- Collaborate with billing staff and clinical team to clarify and resolve any issues affecting claims processing.
- Provide excellent customer service to patients, answering inquiries related to insurance claims and billing.
QUALIFICATIONS AND EXPERIENCE:
- High School Diploma with more than two years of experience in medical billing, coding, or claims management (behavioral health experience preferred).
- Strong knowledge of insurance processes, including Medicaid and Medicare.
- Familiarity with Electronic Health Records (EHR) systems.
- Excellent attention to detail, problem-solving skills, and ability to meet deadlines.
- Strong understanding of CPT and ICD coding standards.
- Proficiency in Microsoft Office and billing software; Ability to interpret and apply healthcare regulations.
- Excellent communication and interpersonal skills for interacting with insurance providers and clinical teams.
Source : Xelerate, LLC
