Occupational Health Insurance Representative

7 months ago

Glen Allen, United States Patient First Full time
The responsibilities of this job include, but are not limited to, the following:
  • Reviewing and addressing processed claims to ensure proper payments are received according to the payers' contract;
  • Reviewing unprocessed claims within the payers' timely filing limits for resubmission of claims for payment;
  • Researching Eligibility of Benefits (EOB) to verify correct payment and adjustments are posted to patient accounts;
  • Researching Eligibility of Benefits (EOB) to determine if unpaid balances need to be appealed to the appropriate Workers' Compensation Committee;
  • Researching denied claims or claims with no response to determine proper follow up steps be taken to obtain payment;
  • Correcting registrations on Workers' Compensation accounts and refiling claims;
  • Maintaining the daily work flow goals established for the Occupational Health Insurance Representatives;
  • Addressing account inquiries and/or update requests in a timely manner;
  • Establishing and maintaining a working relationship with payer representatives to ensure proper claim filing and reimbursement;
  • Effectively communicate trends or issues to the Occupational Health Operations Manager;
  • Keeping informed of all changes relating to Workers' Compensation laws and requirements to ensure proper claim filing and payments;
  • Working through accounts with outstanding balances and collecting from the responsible party;
  • Following departmental and corporate policies and procedures;
  • Responsible for the use and operation of the following equipment: telephone, copier, printer, fax, computer, billing system, Microsoft Office Suite, imaging system, and calculator.
Minimum education and professional requirements include, but are not limited to, the following:
  • Employee must be 18 years of age or older;
  • High school graduate or equivalent;
  • Knowledge of Workers' Compensation laws and policies;
  • Three years of experience working in the healthcare field, preferably in a medical billing department;
  • Excellent analytical, written and verbal communication skills;
  • Ability to prioritize, organize and multi-task in a timely manner;
  • Ability to use Microsoft Excel, Outlook and Word;
  • Must be able to sit for long periods of time;
  • Must be able to use phone system.

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