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Insurance Representative

4 months ago

Bryn Mawr, United States Bryn Mawr Medical Specialists Association Full time

The BMMSA Business Office is looking to add a full-time Insurance Representative to their team. As an Insurance Representative your sole focus and responsibility will be your assigned physician(s) insurance A/R. This function will include, but not be limited to, timely follow up on claims rejected or denied by our clearinghouse and/or the patient's insurance carrier, completion of investigations and appeals according to the prescribed policies of the carrier, communication of corrections required by internal clinical and non-clinical departments including charge entry and registration staff, and assisting patients in understanding their insurance related balances.

Functions/Responsibilities:

- Examination and timely follow up on unpaid claims
- Completions of investigations and/or appeals of rejected or denied claims
- Communication with department staff members regarding required items for claims corrections
- Identification of claims requiring managerial review and assistance
- Assisting patients in the understanding of insurance denials and/or their assigned cost sharing as needed
- Facilitate the identification or rejection and denial trends
- Make corrections to claims information including but not limited to CPT codes, DX codes, referrals, and authorizations as directed by the departments
- Completion of additional duties as assigned by management

Qualifications:

- High school diploma of GED required
- Previous insurance A/R experience preferred
- Ability to understand an insurance Explanation of Benefits including denial reason codes and the appropriate responses to those codes
- General knowledge of ICD-10 and CPT codes
- Customer Service
- Ability to communicate clearly and concisely
- Knowledge of insurances, coverage guidelines, and payment policies
- Self-starter with the ability to work independently in the furtherance of the goals of the team
- Experience with patient accounting and EMR software
- Intergy experience preferred

Monday-Friday from 9am-5pm