Insurance Claims Specialist

1 week ago

White Plains, New York, United States White Plains Hospital Full time
Job Summary

White Plains Hospital is seeking a highly organized and detail-oriented Insurance Follow-Up Representative to join our team. As an Insurance Follow-Up Representative, you will be responsible for initiating follow-up with third-party payers on delinquent accounts and reviewing insurance correspondence to ensure timely and accurate payment.

Key Responsibilities
  • Insurance Follow-Up: Initiate follow-up with third-party payers on delinquent accounts to ensure timely payment.
  • Insurance Correspondence: Review and respond to insurance correspondence in a timely manner to resolve accounts.
  • Billing Information: Supply third-party payers with accurate billing information to facilitate claim adjudication.
  • Payment Reconciliation: Ensure payment is received in accordance with contract terms.
Essential Functions and Responsibilities
  • Account Review: Review third-party outstanding balances and take appropriate steps to resolve and reconcile outstanding balances.
  • Correspondence Review: Review correspondence for appropriate action to resolve accounts.
  • Refund Processing: Research and initiate refunds to patients or insurance carriers as needed.
  • Charge Adjustments: Complete charge adjustments and allowances entries on accounts as needed.
  • Account Recoding: Recode accounts by insurance carrier and plan number and enter into the HIS for re-billing purposes.
  • Rejection Processing: Process rejections on third-party accounts.
  • Billing Edits: Review on-line billing edits for errors, corrections or missing information and enter necessary corrections into HIS.
  • Telephone Support: Assist with telephone calls as needed.
  • Vendor Reconciliation: Work with vendors as necessary to reconcile and resolve outstanding accounts.
  • Contract Compliance: Ensure payers process claims timely and according to contract provisions.
Requirements
  • Education: High School Graduate required.
  • Clerical Experience: Clerical experience preferred.
  • Hospital Business Office Experience: Hospital business office experience preferred.
  • Computer Experience: Computer experience required.
  • Core Competencies: Teamwork, communication skills, problem-solving, adaptability.
Work Environment
  • Physical Demands: May be exposed to chemicals necessary to perform required tasks.
  • Mental Demands: Must be able to remain in a stationary position at least 50% of the time.
  • Communication: Constantly operates a computer and other office productivity machinery, such as a calculator, copy machine and computer printer.

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