Healthcare Claims Specialist

hace 3 días


Cali, Valle del Cauca, Colombia Health Prime Intl Llc A tiempo completo

Cali, Colombia Job Summary and Responsibilities

The Healthcare Claims Specialist is responsible for accurately and timely processing of all insurance and patient payments. Payers either send an Explanation of Benefits (EOB) or Electronic Remittance Advice (ERA) towards the payment of a claim. The cash/payment posting staff posts these payments immediately into the respective patient accounts to reconcile them.

Key Duties and Responsibilities:
• Interpret, evaluate, and clarify research requests to determine potential payment issues.
• Post payments received in different forms into the practice management system, including lockbox remits, electronic remits, undistributed accounts, manual remit posting, zero cash posting, correspondence remit manual posting, unposted/missing payments, and EOB downloads from payer websites.
• Analyze EOB information, including co-pays, deductible, co-insurance, contractual adjustments, denials, and more to verify accuracy of patient balances.
• Review payment information to ensure there is no missing or incomplete information.
• Properly post denials in the practice management system and communicate with the accounts receivable team for timely follow-up.

Necessary Attributes:
  • Strong organizational skills.
  • Excellent attention to detail with a focus on accuracy and quality.
  • Proficient with Microsoft Office Suite or related software.
  • Proficient in English verbally and in written communications.
  • Ability to multi-task, establish work priorities, work with interruptions, prioritize needs to meet required timelines, and deal effectively with confidential information.
Qualifications:
  • High School diploma required.
  • Ability to interpret Explanation of Benefits (EOB) – preferred.
  • Demonstrated ability to work with numbers quickly and accurately with an understanding of basic accounting techniques.

Average salary: $42,000 - $65,000 per year. Compensation may vary based on experience and qualifications.



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