Claims Account Specialist

2 weeks ago

Mobile, Alabama, United States Claimpay Inc Full time
Job Overview

Claims Account Services Representative Overview

The Claims Account Services Representative plays a crucial role in managing outstanding claims, gathering necessary information, and performing essential billing tasks, including claim corrections, resubmissions, and appeals. This position is focused on meeting departmental goals related to productivity and effective claim resolution, ensuring that claims are resubmitted as required. Representatives assist with follow-up inquiries from payors and assess unresolved workers' compensation claims to facilitate their resolution. At Claimpay, Inc., CAS Representatives specialize in handling debts associated with patients receiving in-office dispensed medications under Workman's Compensation.

The initial responsibility of a CAS Representative involves contacting insurance companies and claim adjusters to verify the reimbursement status of unpaid claims that have exceeded 45 days. This verification is primarily conducted through telephone communication and/or insurance company provider portals. In cases of claim denial, the CAS Representative will obtain the Explanation of Benefits from the Claims Adjuster and prepare the necessary appeal documentation to secure reimbursement. The CAS will assign a Claim Status and document all actions taken on a patient's claim within the billing software. Continuous monitoring of the claim will occur until reimbursement is achieved or a determination is made regarding the claim's compensability.

Key Responsibilities

  • Engage directly with insurance companies to clarify their financial obligations related to services provided to clients.
  • Accurately document all communications in the patient's account within the billing system to ensure timely reimbursement.
  • Conduct follow-ups on insurance claims that have been denied and manage the appeals process.
  • Verify eligibility and benefits with insurance companies through phone or online portals.
  • Assist with various billing and collection tasks as required.
  • Perform follow-ups with insurance carriers and claims adjusters on billed claims that have not received responses (no payment or denial) to ascertain claim status and obtain the Explanation of Benefits.
  • Utilize carrier portals to retrieve missing Explanations of Review (EOR) to support management in the appeals process.
  • Review incoming correspondence from payors for relevant information.
  • Report to management any recurring errors or trends identified in billing or with payors that may impact timely and accurate claims processing.
  • Assist in gathering any missing or additional documentation necessary for claim resubmissions.
  • Participate in ongoing quality improvement initiatives, regularly setting goals with supervisors and tracking progress.
  • Maintain confidentiality of Protected Health Information (PHI).

Qualifications

  • High School Diploma or equivalent; an Associate's Degree is preferred.
  • A 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 is essential.
  • Strong attention to detail with the ability to prioritize tasks independently.
  • Capability to multitask effectively 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 read and interpret various documents such as safety rules, operating instructions, and procedure manuals.
  • Competence in writing routine reports and correspondence.

Key Competencies:

  • Intensity
  • Interpersonal skills
  • Effective communication skills - both verbal and written
  • Active listening skills
  • Problem analysis and resolution capabilities
  • Adaptability to changing situations
  • Initiative in task completion
  • Ability to handle stress effectively

Compensation: $15-$18 per hour

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