Praesum Healthcare:
Position Title: Claims Processing Specialist
Founded in 2003, Praesum Healthcare provides administrative services for healthcare providers in key geographical locations throughout the Northeast, mid-Atlantic, and Southeast regions. Praesum is an established leader in the healthcare industry. With a solid, growth-focused business model, strong finances, and expert management team, Praesum will continue to grow in the years to come. Praesum currently provides services to behavioral health facilities providing all levels of care from inpatient psychiatric and substance abuse detoxification, through SUD and mental health outpatient clinics.
Claims Processing Specialist Job Description:
The Claims Processing Specialist will review and audit patient medical records and assign codes to diagnoses and procedures performed by service providers. This position will prepare all billing forms to send to 3rd party biller for timely insurance claim submission. This position will ensure accuracy encompassing billing, coding and insurance requirements, in addition to state and federal laws surrounding Protected Health Information (PHI) and HIPPA, 42CFR, Part 2.

Claims Processing Specialist Duties/Responsibilities:

• Review and audit medical records for accuracy in billing, coding and insurance requirements
• Organize and manage patients’ health information data
• Prepares daily charges and claims to be submitted electronically to clearing house and insurance carriers
• Accounts Receivable follow up with insurance carriers
• Claim denial management with electronic clearing house
• Utilizes 3 different code sets: CPT, HCPCS, and ICD-10 for appropriate billing to insurance carriers
• Release information to persons and agencies according to state and federal regulations
• Possess the ability to critically analyze documentation, assigning proper codes.

Claims Processing Specialist Requirements:

• High School Diploma or GED equivalent required, AA Degree or Vocational training preferred
• A minimum of 2 years of office or related healthcare industry experience
• Working knowledge of Microsoft Office applications

Claims Processing Specialist Schedule:

• Full Time
• Tuesday - Saturday
• 8:30am to 05:00pm

Claims Processing Specialist Compensation:

• Hourly rate competitive with experience and location

Full time employees may be eligible for the following:

• Insurance: Medical, Dental, Vision, and STD options
• Medical FSA and Dependent Care Account
• 401k with company match up to 5%
• Accrued Paid Time Off (PTO)
• Education reimbursement
• Career Advancement Opportunities

* This job does NOT sponsor visa’s and we are unable to consider out of country applicants *
If you are interested in this opportunity or know someone that you respect who would be a good fit for this position, please email:
Clay - Clay@praesumhealthcare.com
James - James@praesumhealthcare.com

• Review and audit medical records for accuracy in billing, coding and insurance requirements
• Organize and manage patients’ health information data
• Prepares daily charges and claims to be submitted electronically to clearing house and insurance carriers
• Accounts Receivable follow up with insurance carriers
• Claim denial management with electronic clearing house
• Utilizes 3 different code sets: CPT, HCPCS, and ICD-10 for appropriate billing to insurance carriers
• Release information to persons and agencies according to state and federal regulations
• Possess the ability to critically analyze documentation, assigning proper codes