Medical Claims Representative

2 days ago


Novi, United States Robert Half Full time
Job DescriptionJob DescriptionWe are in search of a Medical Claims Representative to join our team in NOVI, Michigan. This role is pivotal in the healthcare industry, providing a crucial bridge between patients, healthcare providers and insurance companies. You will have the chance to work in a dynamic environment and contribute to ensuring a smooth and efficient process for medical claims.

Responsibilities:

• Initiate and manage claims from clients, ensuring all necessary documentation is received and properly processed.
• Assign electronic disability claim notifications to the appropriate supervisors or DNCMs following client-specific protocols.
• Conduct member outreach regarding the disability claim review process in line with approved scripts.
• Keep track of incoming claim documents to ensure timely receipt and processing.
• Prepare and dispatch claim correspondence documents to members within established timeframes.
• Utilize various software (Microsoft Office, Excel, Microsoft CRM, Oracle, etc.) to create or modify documents such as reports, memos, and letters.
• Answer incoming telephone calls regarding claims and forward to the appropriate staff member when needed.
• Compile and verify all claim documents to create Recommendation Summaries to be sent to the client upon completion of the disability claim review process.
• Sort and distribute incoming correspondence including mail, faxes, email and/or UPS/FedEx.
• Assist in tracking and trending department turnaround times for reporting purposes.
• Maintain strict confidentiality regarding client, staff, and organizational information.
• Perform general clerical duties including copying, scanning, faxing, mailing, and filing as necessary.
• Upload documents into Spring CM and SharePoint as applicable.

Skills:

• Proficiency in Allscripts, Cerner Technologies, EHR SYSTEM, Epic Clinical, Epic Software.
• Experience in Appeals, Benefit Functions, Billing Functions, Claim Administration, Collection Processes.• Proficiency in Allscripts, Cerner Technologies, EHR SYSTEM, Epic Clinical, and Epic Software
• Experience with appeals, benefit functions, and billing functions
• Knowledge of claim administration and collection processes
• Strong interpersonal and communication skills
• Ability to work independently and within a team
• Detail-oriented with strong organizational skills
• Excellent problem-solving abilities
• Ability to maintain confidentiality and adhere to ethical standards
• Familiarity with medical terminology and healthcare regulations
• Proficiency in Microsoft Office Suite, including Word, Excel, and Outlook
• Strong customer service skills and ability to manage patient inquiries effectively
• Ability to multitask and prioritize tasks efficiently
• Willingness to keep up-to-date with industry changes and advancements
• Strong written and verbal communication skills
• Ability to work in a fast-paced, high-pressure environment.

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