Claims Processing Specialist

Job Summary:

The Spine Team Texas Claims Processing Specialist is responsible for timely and accurate processing of medical insurance claims, resolution of claim edits and rejections, coordination of secondary billing, preparation of payment posting batches.   This position serves as a key member of the revenue cycle team by ensuring claims are properly submitted, payments are tracked, and supporting documentation is accurately maintained to maximize reimbursement and minimize claim delays.

This position requires full understanding and active participation in fulfilling the mission of Spine Team Texas.  The Claims Processing Specialist reports directly to the Revenue Cycle Manager who is under the direction of the Director of Revenue Cycle.

Spine Team Texas Attributes

For Spine Team Texas to meet the goals expressed through the company mission statement, it is imperative that all employees possess the following attributes:

1. Knowledge – The blending of job-related education, skills and experience.
2. Quantity – Level of satisfactory output generated in position per unit time.
3. Accuracy – Absence of errors.
4. Judgment – Capacity to make reasonable decisions.
5. Innovation – Imagination and creativity used to better position.
6. Appearance & Habits – Personal habits, grooming, uniform / clothing.
7. Orderliness – Organization of the individual’s work and work area.
8. Courtesy – Respect for the feelings of others.  Politeness on the job.
9. Cooperation – Willingness to help others accomplish their objectives.
10. Initiative – Voluntarily starting projects.  Attempting non-routine jobs and tasks.
11. Reliability – Dependability and trustworthiness.
12. Perseverance – Steadfast pursuit of job objectives when faced with unexpected obstacles.
13. Stability – Even temperament. Acceptance of unavoidable tension and pressure.
14. Alertness – Ability to quickly understand new information and situations.
15. Professionalism – Professional actions, communications, and attitude.
16. Teamwork– Ability to work in a team for the betterment of staff, patients, and the Company.
17. Observance – Observance of Company policies and procedures.
18. Attendance – Consistent adherence to work schedule.

Job Responsibilities

1. Prepare, review, and submit medical claims to insurance carriers in a timely and accurate manner.
2. Monitor claim batch status and investigate any errors.
3. Review and resolve claim edits through clearinghouse and payor portals.
4. Submit secondary claims using information provided on primary payer EOBs.
5. Scan, upload, and electronically file EOBs, insurance correspondence, checks, and billing documentation.
6. Open, sort, distribute mail.
7. Print and distribute faxes.
8. Prepare payment batches according to protocol for payment posting.
9. Maintain detailed records of all claim submissions.
10. Ensure full compliance with HIPAA regulations and organizational policies.
11. Other duties and responsibilities may be assigned.

Customer Service

All Spine Team Texas employees are required to maintain the highest level of customer service at all times. Employees must always speak in a kind, courteous and professional manner when dealing with a patient/customer or co-worker. Employees are required to fulfill the Spine Team Texas mission of “Offering an Unparalleled Patient Experience!”  All employees must exhibit a spirit of cooperation and positive attitude. Professionalism is to be always maintained.

Team Concept:

Spine Team Texas was founded on a team concept approach. To build and enhance the team, each employee must contribute positive interaction, promote value and be a “team-player” not only for their unit or department, but for Spine Team Texas as a whole.

Physical Requirements & Work Environment

Must be able to sit for long periods of time in a well-lit, air-conditioned office environment.  Must have the ability to lift a minimum of 5 pounds.  Must be able to work under pressure. Tasks involve no exposure to blood or other potentially infectious materials.

Educational Requirements & Position Qualifications:

1. High School diploma or equivalent is required, medical billing certification preferred.
2. 2 to 3 years of experience in medical billing, insurance claims processing, or revenue cycle management operations
3. Preferred knowledge of CPT, ICD-10, and HCPCS coding systems.
4. Knowledge of insurance claim submission processes and reimbursement procedures. 
5. Knowledge of EOBs claims edits, denials, rejections and secondary billing procedures.  
6. Familiarity with electronic health records (EHR), practice managements systems and clearinghouses.
7. Strong organizational skills and attention to detail.
8. Proficiency in document scanning.
9. Strong proficiency in Microsoft Office applications.
10. Proficient in communicating in the English language both written and verbally.