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Claims Specialist

Universal Health Services

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Universal Health Services
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Job Details

Claims Specialist

Job Code:  218758
Facility: Independence Shared Services
Location: MALVERN, PA US Mid-Atlantic
Region: Mid-Atlantic
Travel Involved: 0-10%
Job Type: Full Time
Job Level: 
Minimum Education Required: High School or equivalent 
Category: Office/Clerical
FTE: 1
Position Summary:

The Claims Specialist is responsible for the accurate and timely resolution of professional billing claim and clearinghouse edits as well as payer rejections. This includes registration-based edits, claim requirement data edits (e.g. missing admission date), provider enrollment edits (e.g. missing NPI) and payer-specific edits. Meets or exceeds established performance targets (productivity and quality) established by the Billing Supervisor. Performs root cause analysis and identifies edit trends timely to minimize lag days, mitigate large volume claim submission delays and maximize opportunities to improve process and update the Practice Management System (PMS) logic as needed. Exercises good judgement in escalating identified root causes and edit trends to the Billing Supervisor, as needed, to ensure timely resolution and communication to stakeholders. Demonstrates the ability to be an effective team player. Upholds “best practices” in day to day processes and work flow standardization to drive maximum efficiencies across the team. Communicates effectively with IPM Coders to handle accurate and timely resolution of coding-based claim edits.

Accurately reviews and resolves assigned claim and clearinghouse edits and payer rejections to minimize lag days. Meets or exceeds established performance targets (productivity and quality) established by the Billing Supervisor.
Provides prompt attention to edit trends and identified root causes with timely resolution and escalation to the Billing Supervisor as needed.

Utilizes real time eligibility verification checks accordingly to accurately update patient registration in the Practice Management System (PMS) for registration-based edits. Captures registrations error trends and eligibility tool response issues and reports promptly to the Billing Supervisor.

Initiates support calls to the clearinghouse Help Desk as needed to gain clarification on clearinghouse edits. Communicates clearinghouse edits that are a road block to claim submission, to the Billing Supervisor, so clearinghouse edit/s can be updated as needed.

Partners with IPM Coders to achieve timely resolution of coding-based claim and clearinghouse edits and payer rejections.

Effectively prioritizes work assignment/s and demonstrates flexibility in assuming edits assigned to other Claims Specialists to minimize lag days and ensure team goals/objectives are met.

Participates in regularly scheduled team meetings offering new paths, procedures and approaches to edit resolution to maximize opportunities for performance and process improvement.

Performs other duties as assigned.


Education: High School Graduate/GED required. Technical School/2 Years College/Associates Degree preferred.

Work experience: Experience (3-5 years minimum) working in a healthcare (professional) billing, health insurance or equivalent operations work environment.

Knowledge: Healthcare (professional) billing, knowledge of CPT/ICD-10 coding, claim submission requirements. Understanding of the revenue cycle and how the various components work together preferred.

Skills: Excellent organization skills, attention to detail, research and problem solving ability. Results oriented with a proven track record of accomplishing tasks within a high-performing team environment. Service-oriented/customer-centric. Strong computer literacy skills including proficiency in Microsoft Office.

Equipment Operated: Mainframe billing software (e.g., Cerner, Epic, IDX) experience highly desirable.

If you meet the above requirements and are looking for a rewarding career, please take a moment to share your background with us by applying online. Independence Shared Services offers competitive compensation commensurate with experience and benefit programs including medical, dental, life insurance, and 401(k).

Independence Shared Services is not accepting unsolicited assistance from search firms for this employment opportunity. Please, no phone calls or emails. All resumes submitted by search firms to any employee at IPM via email, the Internet or in any form and/or method without a valid written search agreement in place for this position will be deemed the sole property of Independence Shared Services. No fee will be paid in the event the candidate is hired as a result of the referral or through other means.

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