Insurance Claims Specialist
2 weeks ago
We are seeking a highly skilled and detail-oriented Insurance Billing Representative to join our team at Mercy Health System. As a key member of our Revenue Cycle department, you will be responsible for ensuring claims are resolved with third-party payers in a timely and efficient manner.
Key Responsibilities- Verify claims are received by the payer and follow up to obtain payment via phone calls, portal, or website use.
- Review claim adjustment reason codes or explanations of benefits received by the payer to determine next steps.
- Evaluate and take action to resolve denials, including resubmissions, disputes, appeals, or reconsiderations as required by the payer.
- Draft and submit appeals or reconsideration forms in a logical and relevant format.
- Obtain and send medical records during the appeals process to substantiate medical necessity.
- Review billing forms for accuracy and identify trends with payer rejections or denials.
- Use computer systems and technology to locate claims information and resolve account balances.
- Maintain compliance with patient financial services policies and procedures.
- Interact with other PFS staff members to provide information and ask for guidance to resolve knowledge base deficiencies.
- High school diploma or equivalent.
- Microsoft Excel required and healthcare billing experience preferred.
- Basic understanding of working in multiple software applications at the same time.
The Special Physical Demands are considered Essential Job Functions of the position with or without reasonable accommodations.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee is most often required to sit; use hands to finger, handle, or feel and reach with hands and arms. The employee is occasionally required to stand; walk and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 25 pounds.
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