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Claims Processing Specialist
2 months ago
Position Summary:
The Claims Management Representative plays a crucial role in the follow-up and resolution of outstanding claims. This position involves gathering necessary information, executing basic billing functions, and ensuring timely claim corrections, resubmissions, and appeals. The representative meets departmental productivity targets while addressing unresolved workers' compensation claims to facilitate their resolution. At Claimpay, Inc., our CAS Representatives focus specifically on debts related to patients receiving in-office dispensed medications.
Key Responsibilities:
- Engage directly with insurance providers to verify their financial obligations regarding services rendered to our clients.
- Accurately document all communications in the patient's billing account to ensure prompt reimbursement.
- Conduct follow-ups on insurance claims that have been denied and manage the appeals process.
- Verify patient eligibility and benefits through phone calls or online insurance portals.
- Assist with various billing and collection tasks as required.
- Perform follow-ups with insurance carriers and claims adjusters on claims that have not received responses.
- Utilize carrier portals to obtain missing Explanations of Review (EOR) to support management in the appeals process.
- Review incoming correspondence from payors and report any recurring issues affecting claims processing.
- Gather any additional documentation necessary for claim resubmissions.
- Participate in continuous quality improvement initiatives and set goals with supervisors.
- Maintain confidentiality of Protected Health Information (PHI).
Qualifications:
- High School Diploma or equivalent; an Associate's Degree is preferred.
- Minimum of 2 years of experience in medical billing or collections is preferred.
- Knowledge of Explanations of Benefits (EOBs) and an understanding of copays, coinsurance, deductibles, and denial codes.
- Strong attention to detail with the ability to prioritize tasks independently.
- Ability to manage multiple tasks in a fast-paced office environment.
- Excellent customer service skills.
- Intermediate proficiency in MS Office applications.
- Familiarity with medical billing and collection practices.
- Ability to interpret safety rules, operating instructions, and procedure manuals.
- Competence in writing routine reports and correspondence.
Essential Skills:
- Effective communication skills, both verbal and written.
- Strong listening abilities.
- Analytical skills for problem-solving.
- Adaptability and initiative in a dynamic work environment.
- Ability to handle stress and maintain composure.
Compensation: $15-$18 per hour