A Client Services Specialist in the healthcare field is ensures that patients and clients have a positive experience. They act as a liaison between the company and its clients, in addition to assisting with complaints, orders, account questions, billings, and cancellations. A Client Services Specialist also assists Account Managers to ensure a high level of customer service.

Job Duties

• Brings in customers through answering questions about products or services, as well as suggesting information about other products and services
• Builds, maintains, and improves relationships with clients through regular communication
• Processes documentation based on orders received from clients
• Tracking and recording project progress in multiple CRM systems
• Manages projects through their entire duration
• Assists with other duties and projects as needed

Education and Experience

• A Bachelor’s degree in a related field of study such as Business administration is required
• Strong working knowledge of the healthcare industry is generally preferred
• Proficiency in Microsoft Office applications such as Word, PowerPoint, Excel, and Visio is a must
• The ability to manage multiple projects at one time
• Excellent interpersonal skills are required

A Claims Researcher in the healthcare field works to review insurance claim files to ensure that carriers are exercising their practices in an efficient manner. The Claims Researcher works to produce reports on a daily, weekly, and monthly basis in order to summarize their findings.

Job Duties

• Reviews claim files and reports on the performance levels of services provided by insurance carriers, using a thorough understanding of insurance adjusting practices
• Ensures all claims are handled properly by maintaining a claims management diary system
• Resolves any questions the client or patient may have in regards to the claims process, claims status, and settlements
• Works to ensure that claim submissions that require research or special handling are processed efficiently
• Reconciles claim reserves on a weekly basis to ensure proper tracking and reporting

Education and Experience

• Generally, some college experience in a related field of study such as business or marketing is preferred
• A valid Insurance Adjuster’s license is required
• At least a year of insurance claims adjusting experience is required for most positions
• Impeccable customer service, organizational, and analytical skills are a must
• Possession of excellent written and verbal communication skills needed
• A strong working knowledge of Microsoft Word and Excel is required

A Claims Manager in the healthcare field manages and administrates direction of billing for medical services provided to patients in order to ensure they receive care in the most efficient manner. They work to plan, organize, and direct a medical claims department. A healthcare Claims Manager also coordinates with representatives of outside agencies, and members of the public by providing accurate information in an efficient manner.

Job Duties

Essential functions of a Claims Manager in the healthcare field include, but are not limited to:

• Monitoring billing activities, performance management, and production standards and quality of results
• Providing technical assistance to staff in order to initiate billing to all appropriate payer types
• Analyzes data for bill presentation based on requirements and reviews claims for quality
• Works to prepare or supervise the preparation of processes and bill presentation to ensure quality and accuracy
• Stays up to date on State regulations, and implements changes regarding claims and billing requirements

Skills and Education

• A knowledge of Federal, State, and County codes related to fiscal operations of Health Services
• A knowledge of basic medical terminology
• Ability to analyze and interpret problems in data collection, billing, and accounts receivable
• A bachelor’s degree in a field related to managing claims in the healthcare field such as business administration, accounting, finance, or a related field
• Minimum of a few years of experience in healthcare organization, or processing medical claims is generally required
• Experience in the field above what the minimum requirement is may substitute for some education

A Claims Liaison in the healthcare field serves as the claims payment expert for a company in the healthcare field such as a hospital, clinic, or nursing facility. One of the main focuses of a Claims Liaison is to act as an intermediary between various healthcare services and clients or patients by offering information and education about those services. The Claims Liaison should be able to explain things clearly to their clients and patients with excellent communication skills, in order to build long-lasting relationships with them.

Job Duties

The primary duties of a Claims Liaison in the Healthcare field includes, but may not be limited to:

• Preparing reporting related to claims in a timely manner
• Identifying discrepancies in payments, as well as payment updates
• Work to ensure that claims are processed in a timely manner, and that they are processed in accordance to proper policies and procedures
• Demonstrate a strong knowledge of all relevant products
• Apply any applicable policies, procedure, or guidelines as needed

Skills and Education

• In some instances, a High School Diploma or GED may be acceptable when coupled with appropriate amounts of previous experience
• A minimum of 4 years of experience in a related field such as claims adjudication, or auditing experience required. A Bachelor’s degree in a related field may be substituted for some experience
• Demonstrate strong interpersonal skills, as well as excellent written and oral communication abilities
• The ability to work under pressure and multi task is strongly recommended

A Healthcare Case Manager ensures the quality care of their clients by promoting quality, cost-effective outcomes. They provide management services to children, families, and other caregivers in a variety of settings such as hospitals, assisted living facilities, home, or school to ensure the services they receive are appropriate for their specific needs. A Healthcare Case Manager also works with the families of their clients to make sure care arrangements are in line with the needs and wants of the entire family.

Job Duties

• Engaging clients and families in developing positive, trusting relationships
• Help to manage any emotional distress on the part of the client or their family in resolving crisis situations. Use incredible discretion and judgement when determining an appropriate course of action.
• Maintain the ability to compare and evaluate possible courses of action as required by specific circumstances
• Build and maintain relationships with clients, as well as business type relationships with outside care companies
• Demonstrate great interpersonal skills and ability to work with patients with mental illnesses or emotional disturbances.
• Manage conflict, promote change and growth, and facilitate the growth of all patients
• Use strong collaborative abilities to put together plans for patient care by working with patients and their families to discover their specific needs, and coordinating with outside companies to ensure proper care

Qualifications

• Generally, a Bachelor’s degree in a related field such as human services, with an emphasis in social work, psychology, or rehabilitation is preferred
• A strong familiarity with mental health theory or emerging promising practices is preferred
• Some experience in providing case management support is generally preferred
• Strong interpersonal and communication skills are a must
• Demonstrated strong time management and organizational skills.
• The ability to multitask and manage multiple projects at once time is strongly recommended