What are the responsibilities and job description for the Claims Resolution/Insurance Claim Follow Up Specialist position at Cornerstone Adminisystems Inc.?
Company Overview
Cornerstone Adminisystems, Inc. is an employee-owned company, founded in 1994 with a sole focus on serving the EMS industry. We deliver comprehensive billing and revenue cycle management solutions with a total commitment to delivering the best possible result for every client, every day.
Responsibilities
The Claims Resolution Specialist is responsible for managing and resolving unpaid insurance claims by providing daily problem resolution with insurance carriers, government healthcare programs, such as Medicare, patients and other responsible parties. The goal is to recover maximum revenue possible on each and every unpaid account.
Duties include:
Initiate phone calls to carriers for claim status, denials and status of payment
Handle incoming phone calls related to insurance information from patients and insurance companies
Submit claims to carriers and patients to secure payment on outstanding balances
Identify and submit appeals to carriers for redetermination of claims
Process claim rejections via clearinghouse
Process incoming correspondence for all insurance payer types
Perform all necessary duties to successfully secure payment and close a claim
Validate and qualify refunds for processing
Manage applicable claims resolution workflows
Communicate new industry information and procedures as learned through your daily workflow functions
Provide direct supervisor with ideas and suggestions for system updates and procedural improvements
Complete departmental related projects as needed
Complete all additional duties as assigned
Knowledge
Understanding of insurance, Medicare and Medicaid billing procedures and general practices
Ambulance billing guidelines and regulations
Collection law and guidelines
General computer proficiency and knowledge of Microsoft Office applications
Math, grammar, and spelling proficiency
Skills/Attributes
Excellent time management and prioritization skills
Ability to multitask and meet deadlines
Maintain positive attitude and flexibility
Good customer service and persistence
Strong communicator, written and verbal
Detail oriented and accurate
Investigative nature with problem solving skills
Team player
Employees are expected to protect the privacy of all patient information in accordance with Cornerstone’s privacy policies, procedures, and practices, as required by federal and state law, and in accordance with general principles of professionalism as a third-party billing agent. Failure to comply with Cornerstone’s policies and procedures on patient privacy may result in disciplinary action up to and including termination of employment.
Employees may access Protected Health Information (PHI) and other patient information only to the extent that is necessary to complete their job duties. PHI may only be shared with other employees who need to know specific patient information to complete their job responsibilities related to billing, payment or other company operations.
Employees are expected to report, without the threat of retaliation, any concerns regarding Cornerstone’s policies and procedures on patient privacy and any observed practices in violation of that policy to the designated Privacy Officer.
Employees are expected to actively participate in Cornerstone’s privacy training and are required to communicate privacy policy information to coworkers, students, patients and others in accordance with Cornerstone’s policy.
Disclaimer
The information provided in this description has been designed to indicate the general nature and level of work performed by employees within this job. It is not designed to be interpreted as a comprehensive inventory of all duties, responsibilities, qualifications and working conditions required of employees, assigned to this job. Management has sole discretion to add or modify duties of the job and to designate other functions as essential at any time. This job description is not an employment agreement or contract.
Job Type: Full-time
Pay: $16.00 - $17.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Employee assistance program
- Employee discount
- Health insurance
- Life insurance
- Paid time off
- Retirement plan
- Tuition reimbursement
- Vision insurance
Schedule:
- 8 hour shift
- Day shift
- Monday to Friday
Work Location: In person
Salary : $16 - $17
