FUNCTION OVERVIEW:

As a Medical Claim Representative this position will be instrumental in analyzing and following up on billed medical claims to determine the appropriate course of action to resolve the claims.

FINANCIAL RESPONSIBILITIES:

Direct Accountability

• Resolve cash generating accounts expeditiously to bring in revenue for the client and the company.

Deliverables:

• Able to work an average of 40-50 accounts per day 100% of time
• Able to work accounts with 5% or less error ratio

DUTIES:

Work an average of 40-50 Accounts per Day:

• Follow up on Commercial, Medicare and VA medical claims by phone calls to the insurance companies, websites, if available, or any online resources. Phone calls to the patient may be necessary as well.
• Understanding of medical terminology, diagnosis codes, denial codes, ICD 9-10 Codes, and calculating fee schedules.
• Experience in filing appeals on denied claims when appropriate while working each account/claim.
• Strong understanding of 1500’s and Remittance Advice (RA’s).
• Ability to read and understand EOB’s (Explanation of Benefits).
• Has the experience to know the appropriate questions to ask when calling Medical Insurance companies, and Veterans Administration to get the necessary information to move forward in resolving the claim.
• Understands hospital revenue cycle process and is able to apply when working account.
• Develops a solid understanding of assigned clinic processes in order to review and analyze claims and account receivable functions.
• Identifies clinic issues consistently and communicate this to their manager timely for quick resolution.

Works accounts with a 5% or less error ratio:

• Include key information in account notes consistently
• Able to use the appropriate reason and status codes in the PMS system for each account
• Able to request the correct information from the appropriate entity when attempting to resolve the account.
• Able to ask the appropriate questions when calling insurance companies, doctors’ offices, or the patient.

REQUIREMENTS:

Personality Traits

Sense of urgency

Detail Oriented

Analytical

Stable

Organized

Adaptable

Flexible

Positive

Thorough

Academics:

• High School diploma or equivalent
• Some college preferred

Work Experience:

• 2 or more years of experience in Claims Follow-Up/Receivables.

Competencies:

• Able to type 50 wpm
• 10 key by touch, 8000 kph minimum required
• Team oriented
• Good organizational skills
• Able to work well independently
• Time management skills
• Ability to build a strong work relationship with co-workers and managers. (Any supporting team members)

Job Type: Full-time

Pay: $15.00 - $17.00 per hour

Benefits:

• Health insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Work setting:

• Office

Experience:

• Medical Claims: 3 years (Required)

Work Location: In person