Job Summary:

Charge/Claim Edits Specialist I is responsible for reviewing and performing appropriate actions on charges and claims. This position is the point person within the department responsible for making all charge and claim corrections. The individual in this role will review charge edit and claim edit process flows and make recommendations for possible enhancements. Responsible for reviewing documentation to help ensure accurate charge capture. Follows organizational policies and procedures to ensure consistency of charge capture processes and reimbursements.

Job Responsibilities:

• Analyze charge review rules that require review.
• Execute edits within charge review to achieve account resolution.
• Assist in developing policies and procedures related to Charge Review and Claim Edit Review
• Generate reports to monitor the types of errors and their frequency.
• Research accounts and request any needed supporting documentation.
• Resolve all correction requests accurately and in a timely approach.
• Keep supervisor informed of progress of all tasks.
• Perform related duties as assigned within scope of practice.

Job Qualifications:

• High school graduate or GED certificate is required.
• A minimum of 6 months’ experience in a physician billing or third party payer environment.
• Candidate must demonstrate working knowledge of contracts, insurance benefits, exclusions and other billing requirements as well as claim forms, HMOs, PPOs, Medicare, Medicaid and compliance program regulations.
• Candidate must demonstrate the ability to understand and navigate the payer adjudication process.
• Candidate must demonstrate a strong customer service and patient focused orientation and the ability to communicate, adapt, and respond to complex situations. Including the ability to diffuse complex situations in a calm and professional manner.
• Must demonstrate effective communication skills both verbally and written.
• Ability to multi-task, prioritize, and manage time effectively.
• Functional proficiency in computer software skills (e.g. Microsoft Word, Excel and Outlook, E-mail, etc.)
• Ability to work independently.
• The ideal candidate is a motivated individual with a positive attitude and exceptional work ethic.
• Must successfully complete systems training requirements.
• Patient financial and practice management system experience in Epic and or other of electronic billing systems is preferred.
• Knowledge of medical terminology is preferred.
• Previous experience in an academic healthcare setting is preferred.

Hourly Rate Ranges: $21.63 - $26.44

Note: Our salary offers will fall within these ranges based on a variety of factors, including but not limited to experience, skill set, training and education

61st Street Service Corporation

At 61^st Street Service Corporation we are committed to providing our client with excellent customer service while maintaining a productive environment for all employees. The Service Corporation offers a competitive comprehensive Benefit package to eligible employees; including Healthcare and various other benefits including Paid Time off to promote a healthy lifestyle.

We are an equal employment opportunity employer and we adhere to all requirements of all applicable federal, state, and local civil rights laws.