Public Health Claims Specialist

Overview GENERAL DESCRIPTION The Claims Specialist assists with medical insurance claims filing processes. Reviews insurance claims, investigates and verifies eligibility, transmits routine claims and maintains records. Follow up on unpaid, rejected, or denied claims. The Specialist resolves issues to resubmit claims in error and files appeals on denials when necessary and corrects patient insurance information as needed. This position generates reports and processes requests for information. The Specialist reports problems to the appropriate department supervisor. Qualifications QUALIFICATIONS • High School Diploma, General Education Degree (GED), or an equivalent combination of education and experience in lieu of diploma. • One (1) year of experience in a related field. COMPENTENCIES • Proficient in Microsoft Office Suite • Excellent verbal and written communication • Ability to build strong working relationships • Analytical mindset and problem-solving skills • Meticulous attention to detail • Intermediate math and computer skills • Ability to hold strict confidentiality • Knowledge of PHI and HIPPA regulations PHYSICAL REQUIREMENTS While performing the duties of this Job, the employee is regularly required to sit, use hands to finger, handle or feel, reach with hands and arms, and talk or hear. The employee is occasionally required to stand, walk, climb or balance, and stoop, kneel, crouch, or crawl. The employee must regularly lift and/or move up to 10 pounds, frequently lift and/or move up to 25 pounds, and must occasionally lift and/or move up to 50 pounds. There are no special vision requirements. CERTIFICATES, LICENES, REGISTRATIONS • Must possess a valid driver's license with a driving history verified through a motor vehicle report that meets the requirements for Cherokee Nation underwriting rating. OTHER REQUIREMENTS • The employee must not be and will not be under sanction by the United States Department of Health and Human Services Office of the Inspector General (OIG) or by the General Services Administration (GSA) or listed on the OIG's Cumulative Sanction Report, or the GSA's List of Excluded Providers, or listed on the OIG's List of Excluded Individuals/Entities (LEIE). If you would like to schedule time to speak with an HR Recruiter to discuss your application/resume, please click here, Book time with HR Recruiter . ESSENTIAL DUTIES AND RESPONSIBILITIES • Assists with eligibility and insurance claims filing processes. • Reviews insurance policies to determine coverage. • Investigates and verifies claims eligibility. • Provides follow up on insurance claims to ensure fair and appropriate resolutions to claims and to ensure claims are paid. • Transmits routine claims for payment or advises supervisor if further investigation is indicated. • Conducts and attends meetings and training as required. • Maintains logs and files, tracks claims and payments. • Maintains the privacy of patients and their protected health information (PHI) by following HIPAA regulations. • Manages denial and insurance follow-up and creates appeal letters with the appropriate details of the appeal. • Navigates through various systems while on the phone. • Responds to correspondence from insurance carriers in a timely manner. • Reads and Interprets insurance explanation of benefits. • Contacts third-party payers in a timely manner to determine claim status. • Performs other duties, tasks, and services consistent with this position as assigned. LEVEL OF RESPONSIBILITY • This position does not directly supervise any individuals. • Assignments received with set guidelines, organizes own work, and sets own processes. QUALIFICATIONS • High School Diploma, General Education Degree (GED), or an equivalent combination of education and experience in lieu of diploma. • One (1) year of experience in a related field. COMPENTENCIES • Proficient in Microsoft Office Suite • Excellent verbal and written communication • Ability to build strong working relationships • Analytical mindset and problem-solving skills • Meticulous attention to detail • Intermediate math and computer skills • Ability to hold strict confidentiality • Knowledge of PHI and HIPPA regulations PHYSICAL REQUIREMENTS While performing the duties of this Job, the employee is regularly required to sit, use hands to finger, handle or feel, reach with hands and arms, and talk or hear. The employee is occasionally required to stand, walk, climb or balance, and stoop, kneel, crouch, or crawl. The employee must regularly lift and/or move up to 10 pounds, frequently lift and/or move up to 25 pounds, and must occasionally lift and/or move up to 50 pounds. There are no special vision requirements. CERTIFICATES, LICENES, REGISTRATIONS • Must possess a valid driver's license with a driving history verified through a motor vehicle report that meets the requirements for Cherokee Nation underwriting rating. OTHER REQUIREMENTS • The employee must not be and will not be under sanction by the United States Department of Health and Human Services Office of the Inspector General (OIG) or by the General Services Administration (GSA) or listed on the OIG's Cumulative Sanction Report, or the GSA's List of Excluded Providers, or listed on the OIG's List of Excluded Individuals/Entities (LEIE). If you would like to schedule time to speak with an HR Recruiter to discuss your application/resume, please click here, Book time with HR Recruiter .