Clearinghouse Specialist

GENERAL SUMMARY

The primary responsibility of the Clearinghouse Specialist in healthcare is to manage and coordinate the daily operations and activities within the clearinghouse.

ESSENTIAL JOB FUNCTION/COMPETENCIES

The responsibilities and duties described in this job description are intended to provide a general overview of the position. Duties may vary depending on the specific needs of the affiliate or location you are working at and/or state requirements. Responsibilities include but are not limited to:

• Identifying and correcting errors in claims before submission to payers, including checking for incomplete data, coding issues, and formatting errors.
• Reviewing, processing, rectifying, and submitting claims to the respective payers through secure electronic channels.
• Providing immediate updates on the status of claims, including acceptance, rejection, or additional information required.
• Answering questions and investigating coding issues identified by the clearing house.
• Managing invalid and rejected claims, and working with the clearing house to answer questions and investigate coding issues.
• Performs other position related duties as assigned.
• Employees shall adhere to high standards of ethical conduct and will comply with and assist in complying with all applicable laws and regulations. This will include and not be limited to following the Solaris Health Code of Conduct and all Solaris Health and Affiliated Practice policies and procedures; maintaining the confidentiality of patients' protected health information in compliance with the Health Insurance Portability and Accountability Act (HIPAA); immediately reporting any suspected concerns and/or violations to a supervisor and/or the Compliance Department; and the timely completion the Annual Compliance Training.

CERTIFICATIONS, LICENSURES OR REGISTRY REQUIREMENTS

• N/A

KNOWLEDGE | SKILLS | ABILITIES

• Requires a strong understanding of healthcare billing and coding standards.
• Skilled in data processing ensuring that claims are accurately formatted and submitted.
• Experience in handling electronic claims.
• Understand the complexities of the healthcare claims process.
• Ability to perform tasks such as claim scrubbing, ensuring claims are error free before submission.
• Adept at handling sensitive patient data securely.
• Skill in using computer programs and applications including Microsoft Office.
• Professional verbal and written communication skills.
• Excellent organizational skills and attention to detail.
• Strong analytical and problem-solving skills.

• EDUCATION REQUIREMENTS

• High school diploma or equivalent required.
• Associates level degree preferred.

EXPERIENCE REQUIREMENTS

• 3+ years experience working on clearinghouse rejections.
• 3+ years in revenue cycle management, claims submission.
• Extensive experience with clearinghouse submissions.

REQUIRED TRAVEL

• N/A

PHYSICAL DEMANDS

Carrying Weight Frequency

1-25 lbs. Frequent from 34% to 66%

26-50 lbs. Occasionally from 2% to 33%

Pushing/Pulling Frequency

1-25 lbs. Seldom, up to 2%

100 + lbs. Seldom, up to 2%

Lifting - Height, Weight Frequency

Floor to Chest, 1 -25 lbs. Occasional: from 2% to 33%

Floor to Chest, 26-50 lbs. Seldom: up to 2%

Floor to Waist, 1-25 lbs. Occasional: from 2% to 33%

Floor to Waist, 26-50 lbs. Seldom: up to 2%