Claims Escalation Specialist

In a way, that best supports our values, the individual is responsible for the daily activities of claims escalation (denials management) for Fast Pace. The Claim Escalation Specialist will perform the daily collections and management of outstanding accounts, to include following up with insurance companies, reconciling accounts, filing corrected claims, appealing claims (when appropriate), and following up on all denials to ensure processing/reprocessing, and payments. The Claim Escalation Specialist will provide effective customer service for all internal and external customers by using, excellent, in-depth knowledge as well as communicating effectively with team members and strong customer service. 

Essential Functions:

• Performs daily on collecting and managing of outstanding accounts, to include following up with insurance companies, reconciling accounts, filing corrected claims, appealing claims (when appropriate), and following up on all denials to ensure processing/reprocessing, and payments.
• Collaborates with Manager of Claims Escalation & Processing, and Director of Revenue services to report denial trends to ensure proper claim resolution.
• Collaborates with patients, vendors, and internal departments to resolve conflicts on accounts and resolve any outstanding claims for unapplied/unidentified invoices.
• Ensures accuracy in claims escalation (denials management) while adhering to all regulations.
• Participates with the team to implement and adhere to policies, procedures, and systems to ensure timely resolution of claims in current Practice Management system.
• Ensures adherence to objectives, operating policies and procedures, and strategic action plans for achieving goals.
• Collaborates with Manager of Claims Escalation & Processing to create new processes and procedures as needed to improve overall claims escalation process.
• Performs a variety of administrative duties including, but not limited to: answering phones, faxing and filing.
• Responsible for learning the aspects of compliance in the company by completing all mandatory compliance training.
• The ability to maintain friendly, cordial relations with fellow coworkers.
• The ability to build and maintain confidence and credibility with fellow coworkers.
• The ability to maintain friendly, cordial relations with all clients and employees; maintain a positive work atmosphere by acting and communicating in a manner that results in a positive work relationship with customers, co-workers and managers.
• The ability to perform the physical, use of senses, cognitive, and environmental functions of the position, as specified on the physical demands.
• The ability to comply with company standards of operations.
• Ability to adhere to all of the Core Values of the Company, of teamwork, communication, empowerment, quality care, and friendliness.
• The ability to uphold and maintain a respectful culture of employee, employer and business confidentiality.
• Perform other duties as assigned by management.