What are the responsibilities and job description for the Medical Claims Processor position at Vanguard Group Staffing, Inc.?
The Account Receivables Representative will perform various follow up tasks on out of network surgical and E&M claims, address complex denials and write and submit appeals.
Responsibilities
- Analyzes information, including co-pays, deductibles, co-insurance, adjustments, and denials.
- Obtaining the initial status of medical claims by calling insurance carriers and checking web portals.
- Follow up via carrier communication through phone/online web portals to resolve issues and ensure claims are paid timely and appropriately.
- Experience resolving denials and submitting appeal: Identifies and resolves denials and payment variances and acts to resolve issues through claims reprocessing, claim corrections, and/or drafting and submitting reconsiderations/appeals.
- Reviews, follows up and responds to inquiries via email, phone or incoming correspondence
- Reviews patient account balances to ensure all patient payments are applied appropriately. Contacts patients and other relevant parties to follow up on outstanding balances and make payment arrangements.
- Maintains detailed records of all revenue cycle activities in EMR system.
- Verifies health insurance benefits for patients before submitting claims.
- Reviews and responds to insurance and/or patient refund requests.
Qualifications
- Must have excellent understanding of explanations of benefits, insurance denials, partials payments, adjustments, and recoupments.
- Must have proficiency in Microsoft Office Suite including Outlook, Word, Excel and SharePoint
- Strong written and verbal communication skills.
- Strong analytical and mathematical skills.
- High level of customer service & interpersonal skills
- Knowledge of CPT/ICD10, medical terminology
- Well-organized, self-motivated, and ability to multi-task while working in a fast-paced environment to meet various deadlines
- Familiarity with EMR systems
Education & Licensing
- High School diploma or GED required
- Two years of hospital or private practice surgical claims experience preferably in ENT, bariatrics, orthopedics, plastic & reconstructive surgery or neurosurgery