TriCore Reference Laboratories
Claims Specialist Apprentice - Journal Center
TriCore Reference Laboratories, Albuquerque, New Mexico, United States, 87101
Scheduled Shift: Monday-Friday 8:00AM-5:00PM and other shifts as needed.
Location: Journal Center
JOB SUMMARY:
To work in a supported learning environment to develop the skills and knowledge to advance their qualifications and progress their career as a Claims Specialist within the TriCore Business Office.
ESSENTIAL FUNCTIONS:
1. Follow-up on basic claim denials for assigned accounts or from account receivable reports focusing attention on accounts over 60 days from primary and secondary payors working to resolution of account while gradually progressing to higher complexity denials.
2. Perform research of denials and unpaid claims making appropriate corrections until worked to resolution to include phone call, claims resubmission, appeal or reconsideration.
3. Complete BBP report to account resolution.
4. Demonstrate a working knowledge of basic healthcare contractual obligations such as claim filing limits, medical necessity and dual coverage through accurate and timely claims filing while progressively increasing understanding of payer policies and procedures.
5. Accurately verify eligibility on patient accounts using online insurance resources.
6. Work payer correspondence received.
7. Researches adjustments and pulls all necessary backup to support adjustments.
8. Communicate effectively and professionally to all customers (internal and external) using key words as appropriate.
9. Maintain confidentiality of patient and client information. Responsible for following TriCore safety, personnel, and billing department policies. Must participate in training as requested by Supervisor/Manager.
10. Meet all Quality Assurance (QA) accuracy and data.
MINIMUM EDUCATION:
High School Diploma or equivalent
MINIMUM EXPERIENCE:
No experience required.
OTHER REQUIREMENTS:
Must have basic PC knowledge and working expertise with keyboard, mouse, Internet, and Windows based applications.
Must be able to type 30 words per minute (typing test required)
PREFERRED:
One year in a healthcare setting.
Location: Journal Center
JOB SUMMARY:
To work in a supported learning environment to develop the skills and knowledge to advance their qualifications and progress their career as a Claims Specialist within the TriCore Business Office.
ESSENTIAL FUNCTIONS:
1. Follow-up on basic claim denials for assigned accounts or from account receivable reports focusing attention on accounts over 60 days from primary and secondary payors working to resolution of account while gradually progressing to higher complexity denials.
2. Perform research of denials and unpaid claims making appropriate corrections until worked to resolution to include phone call, claims resubmission, appeal or reconsideration.
3. Complete BBP report to account resolution.
4. Demonstrate a working knowledge of basic healthcare contractual obligations such as claim filing limits, medical necessity and dual coverage through accurate and timely claims filing while progressively increasing understanding of payer policies and procedures.
5. Accurately verify eligibility on patient accounts using online insurance resources.
6. Work payer correspondence received.
7. Researches adjustments and pulls all necessary backup to support adjustments.
8. Communicate effectively and professionally to all customers (internal and external) using key words as appropriate.
9. Maintain confidentiality of patient and client information. Responsible for following TriCore safety, personnel, and billing department policies. Must participate in training as requested by Supervisor/Manager.
10. Meet all Quality Assurance (QA) accuracy and data.
MINIMUM EDUCATION:
High School Diploma or equivalent
MINIMUM EXPERIENCE:
No experience required.
OTHER REQUIREMENTS:
Must have basic PC knowledge and working expertise with keyboard, mouse, Internet, and Windows based applications.
Must be able to type 30 words per minute (typing test required)
PREFERRED:
One year in a healthcare setting.