Insurance Representative

General Summary: A nonexempt position responsible for the proper and timely processing of claims and payments to providers.

Essential Job Responsibilities:

• Weekly review of claim edits reports and corrects the claim information such as (CPTs, valid ICD-10's, referring doctor name/UPIN #, modifiers, etc.).
• Work and corrects claim rejections from Navicure, correcting necessary data.
• Daily follow-up of aged and denied charges.
• Keep A/R Supervisor informed on all Payer problems.
• Contacting insurance carriers via phone or website.
• Handle patient and provider calls in reference to claims or statements.
• Answer and forward incoming calls in a timely manner.
• Identifies and resolves patient billing complaints.
• Performs various collection actions including contacting patients by phone, correcting, and resubmitting claims to third party payers.
• Identify and correct posting errors and overpayments.
• Review and correct COB errors.
• Other duties and projects as assigned.
• Occasional overtime may be required.

Education: Bachelor's degree in health or business administration.

Experience: Minimum two years of experience in claims processing in a health care setting.

Other Requirements: None

Performance Requirements:

Knowledge:

• Knowledge of clinic policies and procedures.
• Knowledge of health care insurance claim practices and compliance.
• Knowledge of computer systems, programs, and applications.
• Knowledge of medical terminology.

Skills:

• Skill in gathering and reporting claim information.
• Skill in trouble-shooting claim insurance problems.
• Skill in written and verbal communication and customer relations.

Abilities:

• Ability to work effectively with physicians, other medical staff, and external agencies.
• Ability to identify and analyze claim problems.

Equipment Operated: Standard office equipment including computers, fax machines, copiers, printers, telephones, etc.

Work Environment: Position is in a well-lighted office environment. Occasional evening and weekend work.

Mental/Physical Requirements: Involves sitting approximately 90 percent of the day, walking or standing the remainder.