ClaimsSpecialist

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. Collaboration: Work closely with prior authorization, billing, and reimbursement teams to resolve complex claims and support cross-functional RCM initiatives. Compliance: Stay current with payer requirements, coding updates (CPT, ICD-10), and regulatory changes affecting laboratory claims. Reporting: Generate and analyze claims performance reports to identify trends, opportunities for process improvement, and support management decision-making. Education, Experience, and Skills Associate’s or Bachelor’s degree in healthcare administration, business, or related field (preferred). 2+ years of experience in medical claims processing, preferably in a diagnostic laboratory or healthcare setting. Strong knowledge of insurance billing, payer requirements, and denial management. Familiarity with laboratory coding (CPT, ICD-10), EOBs, and remittance advice. Proficiency with billing software and Microsoft Office Suite. Excellent attention to detail, organizational, and communication skills. Ability to work independently and collaboratively in a fast-pace