Optimum RTS - Claims Specialist
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Claims Specialist

Job Type : Direct
Hours : Full Time
Required Education : High School, Associates desired
Travel : No
Relocation : No
Job Industry : Healthcare - Health Services
Job Category : Healthcare - Laboratory/Pathology Services

Job Description :

Claims Specialist




Assist Medical Billing & Collections Managers with all daily tasks related to the billing & collection processes.


Claim Specialist experienced in all aspects of billing & collection processes for out of network laboratory This will include verification of patient insurance coverage, processing denials from insurance payers, bills (1500 form) to both commercial and governmental payers, collect and retrieve patient medical records for commercial and governmental payers. Minimum 1 year of medical billing and collections experience.




  • Understand and participate in all aspects of the billing & collection processes.

  • Verify patient insurance coverage; attain required referrals or authorizations when needed.

  • Responsible for working denials from insurances daily.

  • Identify billing issues and determine the source of the problem to ensure it does not occur in the future.

  • Bill (1500 form) to both commercial and governmental payers.

  • Prepare, store and retrieve patient health records (commercial and governmental payers).

  • Perform other duties as assigned by department manager.

  • Complete required trainings, and additional recommended trainings that can help promote compliance with a variety of employment obligations.



Required Qualifications :




  • High School Diploma or GED.  Associate degree desired.



  • 1 year of Medical billing.

  • Medicare Claims and Commercial Insurance Claims.

  • Knowledge / familiarity with medical terminology.

  • Microsoft




  • Ability to process high volumes of work, without errors.

  • Ability to analyze, evaluate and report data without oversight. 

  • Ability to apply policies and procedures; performs job safely with respect to others, to property, and to individual safety and works effectively with others.

  • Needs to be familiar with ICD-10, CPT, and/or HCPCS Coding Systems as well as claim form CMS-1500.

  • Ability to accurately process high volumes of work within a short period of time. 

  • Ability to prioritize, meet deadlines and maintain strong working relationships with others, internally and externally. 

  • Ability to multitask in a fast-paced environment and willingness to adapt to change.

  • Prolonged periods of sitting at a desk and working on a computer.





  • Maintains strict confidence of patient, client, company and employee information.

  • Proudly services the company by following all HIPAA, JCAHO, state, and federal laws and standards.

  • Strives to deliver high-quality results at all times in accordance with standards.

  • Positive attitude and team player.

  • Excellent organization skills, verbal and communication skills.

  • Accepts ownership for all tasks and responsibilities.

  • Actively explores new educational pursuits to improve job knowledge and skills

  • Maintains good attendance and punctuality.


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