Failed Claims Specialist 2

Scope of Position:

The Failed Claims Specialist 2 functions in the revenue management unit supporting hospital claims processing and charge capture processes. Responsible for maintaining current knowledge of the various regulatory agency guidelines and assure requirements are met along with accurate, complete, and timely charge processes. The primary responsibility of staff within the Revenue Cycle division is to ensure the compliant collection of net revenue for services rendered.

Position Summary:

The Failed Claims Specialist 2 reviews hospital claims to compliantly apply and resolve claim edits specific to non-Medical Information Management CPT/HCPCS coded charges. Responsible for charge capture for various infusion and emergency departments. Performs charge audits and provides feedback on any opportunities for improvement with charge code selection. Familiarity with medical claims processing and pre-bill edit experience for hospital accounts services which includes: modifiers, CPT, ICD10 and HCPCS; LCDs/NCDs; rejected claims after claim submission, and resubmission of encounters that have failed claim edit logic. May serve as informal resource for less experienced colleagues.

Required Qualifications:
Minimum requirement is high school diploma or general education degree (GED). Workable knowledge of medical terminology is required. Certification or vocational training may be preferred. PC Knowledge and interpersonal, verbal, and written communication. Minimum 6 months experience in customer service or a healthcare environment. Knowledge and understanding of reimbursement methodologies and revenue cycle functions.