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Claims Account Services Representative Job Description

The Claims Account Services Representative is responsible for conducting follow-up on outstanding claims, gathering additional information requested, and basic billing functions, including claim corrections, resubmissions, and appeals. Meets department targets regarding productivity and claim resolution and re-submits claims as needed. Assisting with follow-up requests from payors and evaluating unresolved workers comp claims to facilitate resolution. CAS Representatives at Claimpay, Inc. are a specific subset of collectors and specialize in all debts relating to Workman's Compensations patients who receive in office dispensed medication.

The first step of a CAS Representative is to contact insurance companies and claim adjusters to verify the status of reimbursement on unpaid claims that are aged over 45 days. This is accomplished mainly via telephone contact and/or verification from Insurance Company Provider Portals. If a claim is denied, the CAS Representative will obtain the Explanation of Benefits from the Claims Adjuster, as well as prepare and submit the necessary appeal to obtain reimbursement. The CAS will assign a 'Claim Status' and provide 'Notes' in the billing software for all actions taken on a patients claim. The CAS will continue to monitor the claim until reimbursement is obtained, or determination of the claim is rendered non-compensable.

CAS Representatives are responsible for all functions related to the collection on patient claims. Duties are generally assigned on a primary basis, but all personnel are cross-trained and may perform functions in the various business segments.

Primary Responsibilities

• Communicate directly with insurance companies regarding their financial responsibility from services with our clients.
• Document all calls timely and accurately in the patients' account in the billing system to achieve timely reimbursement.
• Perform insurance claim follow-ups for insurance denials and appeals.
• Contact insurance companies to check eligibility and benefits via phone or online portals.
• Assist with other billing/collection duties, as needed.
• Performs claim follow-up with insurance carriers and claims adjusters on billed claims with no response (no payment or denial received) to obtain claim status and Explanation of Benefits.
• Utilize carrier portals to obtain missing Explanation of Review (EOR) to assist management in the appeals process.
• Review incoming correspondence from payors.
• Reports to management any consistent errors or trends identified with billing or payors that affect timely and accurate claims processing.
• Assist in gathering missing or additional supporting documentation necessary to resubmit claims.
• Participates in continuous quality improvement efforts, regularly establishes goals with supervisors, and tracks progress.
• Maintain confidentiality of PHI.

Qualifications

• High School Diploma or equivalent; Associates Degree preferred.
• 2 years of office experience in medical billing / collections preferred.
• Must possess knowledge of Explanation of Benefits (EOB's) and understanding of copays, coinsurance, deductibles, and denial codes.
• Attention to detail and have the ability to prioritize independently.
• The ability to multi-task and in a busy office environment.
• Proficient customer service skills.
• Intermediate knowledge of MS Office.
• Knowledge of medical billing/collection practices.
• Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
• Ability to write routine reports and correspondence.

Ability to speak effectively before groups of customers or employees of an organization.

• Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
• Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.
• Ability to deal with problems involving several concrete variables.

Key Competencies:

• INTENSITY
• Interpersonal skills
• Communication skills -verbal and written
• Listening skills
• Problem analysis and problem-solving
• Adaptability
• Initiative
• Stress tolerance

Compensation details: 15-18 Hourly Wage

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