Claims Account Specialist
2 weeks ago
Claims Account Services Representative Overview
The Claims Account Services Representative plays a crucial role in managing and resolving outstanding claims. This position involves gathering necessary information, executing basic billing tasks, and ensuring timely claim corrections, resubmissions, and appeals. The representative is expected to meet departmental productivity targets while facilitating the resolution of unresolved workers' compensation claims.
Initially, the CAS Representative contacts insurance providers and claims adjusters to verify the status of unpaid claims that are over 45 days old. This is primarily achieved through telephone communication and verification via Insurance Company Provider Portals. In cases of claim denial, the representative will procure the Explanation of Benefits from the Claims Adjuster and prepare the necessary appeal documentation to secure reimbursement. Each claim is meticulously documented in the billing software, including status updates and notes on actions taken.
Responsibilities include:
- Direct communication with insurance companies regarding their financial obligations related to services provided to clients.
- Timely and accurate documentation of all calls in the patient's account within the billing system to ensure prompt reimbursement.
- Follow-up on insurance claims for denials and appeals.
- Verification of eligibility and benefits through phone or online portals.
- Assistance with various billing and collection tasks as required.
- Conducting follow-ups with insurance carriers and claims adjusters on billed claims that have not received responses.
- Utilizing carrier portals to obtain missing Explanation of Review (EOR) documents to aid in the appeals process.
- Reviewing incoming correspondence from payors.
- Reporting any recurring errors or trends identified in billing or with payors that could impact timely claims processing.
- Assisting in the collection of missing or additional documentation necessary for claim resubmissions.
- Engaging in continuous quality improvement initiatives, setting goals with supervisors, and tracking progress.
- Maintaining the confidentiality of Protected Health Information (PHI).
Qualifications:
- High School Diploma or equivalent; an Associate's Degree is preferred.
- Two years of experience in medical billing or collections is preferred.
- Knowledge of Explanation of Benefits (EOBs) and an understanding of copays, coinsurance, deductibles, and denial codes.
- Strong attention to detail with the ability to prioritize tasks independently.
- Capability 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 read and interpret various documents, including safety rules and operational instructions.
- Competence in writing routine reports and correspondence.
Key Competencies:
- Intensity
- Interpersonal skills
- Effective verbal and written communication
- Active listening skills
- Problem analysis and resolution
- Adaptability
- Initiative
- Stress management
Compensation: $15-$18 per hour
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