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Medical Claims Examiner
3 months ago
We are hiring for Health Insurance/ Medical Claims specialists to support a growing healthcare company in the Waco area As a claims follow up specialist on our team you will be verifying insurance information, following up with payors, doing research on insurance coverage, and updating patient information as appropriate as well as communicating with insurance companies and payors to support our clients. If you have experience working within medical insurance roles handling claims, payer portals, appeals, AR follow up, denials or anything within revenue cycle we would love to chat with you
*Job Description & Duties:*
The duties include working with payers to resolve issues and facilitate prompt payment of claims.
Thorough knowledge and understanding of patient billing, claims submission, and payer specific requirements is a must.
This position is highly focused on the resolution of insurance processing errors and denials.
Payers include but are not limited to Medicare, Medicaid, Blue Cross, and commercial health insurance carriers.
Reduce outstanding accounts receivable by managing claims inventory
Speak to insurance companies in a professional?manner regarding patients outstanding balances
Gather information from patients, clients/family members, client clinical areas, government agencies, employers, third party payors and/or medical payment programs, etc. both in-person and by telephone to register patients, gather or update information, obtain referrals and pre-authorizations, complete appropriate forms, conduct evaluations, determine benefits and eligibility (insurance, public programs, etc.), determine financial responsibility and/or to identify sources of payment for services.
Request, input, verify, and modify patients demographic, primary care provider, and payor information
Utilize tools, including computer programs, when indicated
Provide excellent customer service and timely response to questions and issues related to benefits, billing, claims, payments, etc.
Answer questions by phone and provide quotes for services; identify financial resources, etc. in accordance with the client policies and procedures
Utilize various databases and specialized computer software for revenue cycle activities including eligibility verifications, pre-authorizations, medical necessity, review/updating of patient accounts, etc.
Input, retrieve, and modify information and data stored in computerized systems and programs; generate reports using computer software
Explain charges, answer questions, and communicate a variety of requirements, policies, and procedures regarding patient financial care services and resources to patients, staff, payors, and agencies
Work with Claims and Collections in order to assist patients and their families with billing and payment activities in order to increase cash flow
*Day to Day Duties:*
Each specialist will be assigned an inventory to work. New accounts assigned every day.
Work off of a worklist on either EPIC or Cerner. *trained for each inventory*
Work account to account. Every account is different and the insurance company has either paid it and left a balance or denied it and the Insurance rep needs to assist
Could be coded incorrectly or certain coverage(need to have people who can understand how insurance is processed to push the account through)
Logging into payor websites.
Sometimes read through EOBs and it will clear the checklist.
Depending on what account, productivity expectation is around 50 a day.
-Communicating with team via teams chat for feedback or questions.
About TEKsystems:
We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
