Claims Support Specialist

Prometheus Laboratories Inc. - San Diego, CA

Full-timeEstimated: $30,000 - $40,000 a year
Under general supervision monitors and supports claim appeals on all insurance claims and pending documentation necessary to resolve claims. This position will be expected to maintain a comprehensive understanding of general coding and billing compliance, the adjudication process and contractual obligations specific to various payers.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

Support the follow-up and appeals team
Request and prepare medical records
Verify and resolve patient eligibility
Contact customers to verify insurance information
Contact insurance companies to validate missing information
Correct claims for re-submission
Process correspondence and able to identify documents that need to be escalated
Scanning and indexing of correspondence and miscellaneous documentation
Ability to establish and maintain effective working relationships
Able to reach and maintain department productivity and quality goals
Ability to meet individual and team goals with minimal errors as assigned
Uphold Medicare, Medicaid, and HIPAA compliance guidelines in relation to billing, collections, and PHI information
Participates in educational activities and attends staff meetings
Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations
Regular and reliable attendance

High school diploma or general education degree (GED); or one to three months related experience and/or training; or equivalent combination of education and experience. Previous laboratory billing experience preferred.