The Insurance Representative is responsible for analyzing, investigating, following up on denied and/or underpaid claims, as well as patient balances, to facilitate payment and resolution with patient accounts.
Required Skills/Abilities:
-
Knowledge of billing policies and regulations
-
Knowledge of g4/PM System, Onbase, and Availity.
-
Knowledge and experience with CPT, ICD-10-CM, HCPCS codes and EMR systems.
-
Knowledge of medical terminology and medical oncology treatment course.
-
Knowledge of Medicare guidelines and coverage determinations (LCD, NCD, etc.).
-
Ability to adapt to changing billing requirements by CMS.
-
Understanding of claims appeal process.
-
Ability to work in MS Office environment.
-
Ability to handle multiple and conflicting priorities.
-
Ability to work independently and collaboratively within a team environment.
-
Ability to maintain good working relationships.
- Demonstrates attention to detail.
-
Demonstrates professionalism in appearance/dress code.
Certifications/Licenses/Education/or Experience in a related field:
- High School Diploma or equivalent.
-
Minimum of 1-2 years of medical office experience, preferred.
-
Insurance and billing experience preferred.
Physical Requirements:
- Will require extensive desk use and computer use.
-
Light lifting may be required.
Work Environment:
- The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. Reasonable accommodation may be made to enable individuals with disabilities to perform essential functions.
Job Duties / Responsibilities: Including, but not limited to, the following:
-
Review claim issues to determine the accuracy of reimbursement payments.
-
Provide medical records and/or other requests to substantiate payment of claims to insurance payers.
- Review and resolve assigned tasks in the Unity/Centricity queue.
-
Able to organize and prioritize tasks to complete all work assigned in a timely manner.
-
Routinely monitors all high balance accounts to ensure follow up activity.
-
Develops monthly action plans to lower A/R and increase cash flow.
-
Answer all patient calls professionally to help to resolve any claims or billing questions.
-
Informs departmental leadership of any insurance related issues of importance.
-
Maintains patient and clinic confidentiality and adheres to clinical standards, policies, & procedures.
- Maintain a professional relationship with physician teams.
-
Maintain pleasant/helpful attitude towards patients and staff.
-
Perform all related duties as required by Revenue Cycle Manager(s), Business Office Director, CFO, and CEO.
