Claims Specialist

Summary

The Claims Specialist is responsible for managing the end-to-end claims process for diagnostic laboratory services, ensuring timely and accurate submission, follow-up, and resolution of insurance claims. This role is critical to maximizing reimbursement, reducing denials, and supporting the financial health of the laboratory.

Job Responsibilities

• Claims Submission: Prepare, review, and submit claims for diagnostic lab services to commercial and government payers, ensuring compliance with payer guidelines and laboratory policies.
• Denial Management: Analyze denied claims, identify root causes, and initiate corrective actions including appeals and resubmissions.
• Follow-Up: Proactively follow up on outstanding claims, monitor aging reports, and communicate with payers to resolve issues and expedite payment.
• Documentation: Maintain accurate records of claim status, correspondence, and payer responses in the billing system.