Business Office Insurance Representative

JOB SUMMARY

The Business Office Insurance Representative is responsible for the submission of claims for processing, follow up of all insurance claims, Incorrect payments, appeals. Working denials  and A/R and reports, handling billing and insurance calls as required, referring patients for assistance and setting up payment plans and other duties as assigned or needed.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

• Prepares and sends insurance claims to the payers electronic or on paper.
• Monitors claims for missing information and authorizations.
• Send medical documentation as required or requested by the insurance companies.
• Follows up with all insurance companies on unpaid claims.
• Research all denials with the appropriate reason codes.
• Manages the worklog tasks for accounts receivable and insurance denials.
• Completes paper A/R reports and sends appropriate appeals, corrected claims, medical documentation as required by the payer.
• Send tasks to appropriate department (clinical, optical, front office) to obtain additional information or to correct diagnosis/procedure code information.
• Sends FYI tasks to staff for training purposes.
• Answers incoming calls from patients, staff, insurance companies, and other medical facilities regarding insurance and/or billing concerns.
• Reviews and completes a variety of Business Office Reports.
• Follows up on any patient concerns and resolves any patient issues or completes patient complaint forms for follow up.
• Possesses knowledge of CPT and ICD-10 codes
• Corrects edit/errors, maps payers, and monitors claims processing on Availity website.
• Keeps staff updated on billing requirements and changes for insurance types.
• Verifies eligibility and claims status on websites.
• Obtains authorizations for services provided
• Refers and gives information to patients for medical assistance programs.
• Processes and posts payroll deduction payments for employee accounts.
• Monitors and sends collection agency accounts, payments and general correspondence.
• Processes and opens incoming mail, sends outgoing mail, and handles returned mail.
• Posts medical records charges on patient accounts.
• Reviews all emails.
• Scans checks for deposits.
• Performs other duties as required.            

QUALIFICATIONS                               

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Individuals must have knowledge of medical insurance, excellent communication and organizational skills, proficient on most software applications and be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION and/or EXPERIENCE

Associate’s Degree in related field preferred; one year certificate from college or technical school; or three years or more related experience and/or training; or equivalent combination of education and experience.

LANGUAGE SKILLS

Ability to read and comprehend simple instructions, short correspondence, and memos.  Ability to write simple correspondence.  Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.

MATHEMATICAL SKILLS

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.  Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

REASONING ABILITY

Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions.  Ability to deal with problems involving a few concrete variables in standardized situations.

PHYSICAL DEMANDS                                                                                                                           

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.  Specific vision abilities required by this job include ability to adjust focus.

WORK ENVIRONMENT                                                                                                                        

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually quiet.