QualDerm Partners

Claim Specialist

• Manage claims returned which have failed scrub rules
• Identify and resolve payer rejections in a timely manner
• Enter charges/bills into EMR in coordination with the certified coding team/Coding manager
• Monitor missing charges and communicate with RCM management as needed
• Contact payers when necessary to resolve issues
• Report trends preventing successful claim submission to RCM leadership
• Communicate effectively with Coding, AR/Follow-up, Patient Services, and Posting departments
• Enter bills/charges with input from the certified coding team when necessary

Claim Edit Specialist – Laboratory

Accounts Receivable

• Handle day-to-day billing, claims issues, denials, and follow-up for assigned regions/locations.
• Research, identify, and rectify circumstances affecting delayed submission or payment of accounts.
• Communicate accounts receivable issues proactively to management to ensure compliance and accuracy.
• Identify causes of claim denials and resolve them with minimal assistance.
• Analyze problems and report denial and payer trends.
• Follow up on unpaid claims within standard billing cycle timeframes.
• Prepare and submit corrected/replacement claims, reconsiderations, appeals, medical documentation, and other necessary payer documents via fax and provider portals.
• Make outbound payer calls to resolve claims and payment issues.
• Ensure patient medical information is accurate and up to date.
• Meet productivity requirements established by the organization and external benchmarks.
• Provide reporting and communicate accounts receivable issues to the team lead.
• Use the billing system to document patient accounts using proper grammar, spelling, and syntax.
• Provide administrative assistance, including support for internal/external audits.
• Maintain current knowledge of payer policies and guidelines.
• Perform additional assigned duties and projects.

Claim Edit Specialist – Laboratory

Accounts Receivable Specialist