Closing Claims Specialist

US-VA-Roanoke
Req No.
2018-8218
Type
Regular Full-Time

Overview

The Claims Control Specialist is responsible for the final stages of closing and invoicing clients’ individual cases. The Claims Control Specialist works directly with the Hospital Directors to meet the strategic goals established for each client. Assistance will be given to the Hospital Directors on special client projects.

Responsibilities

Documentation requests from Client

  • Request any required forms missing from initial claim submission
  • Request via email any needed documentation identified by Claims  Analyst

Preparation of Final Reports

  • Verify Hospital Compliance Analysis Tool (H-CAT) generated Summarized Report (client and facility) against the original UB-04 submitted and identify any discrepancies.
  • Correct any Client Summarized Report discrepancies
  • Correct any Hospital Detailed Report discrepancies
  • Perform adjustments to Summarized and Detailed Reports for appeal changes
  • Other B2B claim issues as needed

Reimbursement Analysis

  • Analyze the client provided coversheet for correct reimbursement
  • Review contract provided to determine the correct reimbursement if needed
  • Adjust H-CAT to reflect the correct reimbursement, savings, and invoiced amount

Close B2B Cases

  • Make note in system, final report completed
  • Change the status to reflect next stage (Resolutions/Invoiced)
  • Client pays based on report - upload Summarized Report to clients FTP with email notification  
  • Fax facility Detailed Report with cover letter based on specific client instructions
  • Client pays based on signed confirmation letter - upload letter to client FTP with email notification
  • Completes final appeal reversals, adjust Summarized Report and upload to FTP and email notification
  • Other closing issues as needed

Invoice Closed Cases          

  • Verify invoice is correct and upload and/or email to appropriate parties
  • Update status in system to invoiced
  • Create invoice or complete pre-weekly invoice spreadsheet 
  • Create credit memos as needed
  • Handle other invoicing issues as needed

Assist Hospital Directors

  • Prepare reports for business trips
  • Other special client projects and meetings as needed

Qualifications

  • 1+ years related work experience in health insurance or medical claims processing

  • Excellent written and verbal communications skills
  • Two years’ experience working in Excel and Access programs
  • Ability to multi-task
  • Good organizational skills
  • Proficient with numbers
  • Proficient data entry skills with accuracy
  • Excellent attention to details
  • Ability to follow procedures

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