Top 967 Member service representative Jobs in Philadelphia Pa

Insurance and Denials Specialist
Careers at Gentell —Morrisville, PA
- $23 - $25 an hour
- Full-time
- Customer service
- Research
- Mid-level
Quick Apply
Call Center Representative
Police and Fire Federal Credit Union —Bensalem, PA
- Computer literacy
- Mid-level
- Fair chance
- Health insurance
- Dental insurance
12d
Licensed Insurance Sales Representative (Remote / Home-Based)
Allstate —Philadelphia, PA
- $18 an hour
- Weekends as needed
- Remote
- Computer literacy
- High school diploma or GED
- US work authorization
- Paid training
- Dental insurance
Wealth Management Trainee (PA)
Bankers Life —King of Prussia, PA
- $50,000 - $80,000 a year
- Full-time
- Customer service
- No experience needed
- Entry level
Quick Apply
Member Service Representative
Trumark Credit Union —Malvern, PA
- Full-time
- Office
- High school diploma or GED
- 1 year
- Health insurance
- Dental insurance
Quick Apply
Customer Service Rep (Premier)
Independence Blue Cross —Philadelphia, PA
- Remote
- Bilingual
- Research
- Mid-level
20h
Customer Service Representative
Jefferson Methodist Hospital —Philadelphia, PA
- $23.60 - $28.42 an hour
- Part-time
- Bilingual
- Google Workspace
- Computer literacy
- 401(k)
- Flexible spending account
Quick Apply
6d
Patient Services Representative - OB/GYN Millenium
Redeemer Health —Philadelphia, PA
- Full-time
- High school diploma or GED
- Computer skills
- Communication skills
- Health insurance
- Dental insurance
Member Service Representative
Transit Workers Federal Credit Union —Philadelphia, PA
- $21 - $24 an hour
- Part-time
- Background check
- Microsoft Excel
- Microsoft Outlook
Quick Apply
Medical Secretary
Holy Family Home —Philadelphia, PA
- Part-time
- Nursing home
- Ability to walk for extended periods
- Computer literacy
- Paid time off
Quick Apply
1d
Patient Care Coordinator
CCRM Fertility —Philadelphia, PA
- $25 - $30 an hour
- Full-time
- HIPAA
- Mid-level
- High school diploma or GED
- Commuter assistance
- Health savings account
Quick Apply
Member Service Representative I (PAT) - Call Center
American Heritage Credit Union —Philadelphia, PA
- $18 - $21 an hour
- Urgently hiring
- Hybrid work
- Entry level
- Health insurance
- Dental insurance
Quick Apply
6d
Patient Service Representative
The Family Practice & Counseling Services Network —Philadelphia, PA
- $16.00 - $19.75 an hour
- Full-time
- Computer literacy
- Ability to climb stairs
- High school diploma or GED
Quick Apply
Customer Service Representative I
Versant Health —Philadelphia, PA
- $16.50 - $17.75 an hour
- Full-time
- Remote
- HIPAA
- High school diploma or GED
- 1 year
- Health insurance
- Dental insurance
Operations Clerk
ASPIRAS BILINGUAL CYBER CHARTER SCHOOL —Philadelphia, PA
- $37.50 an hour
- Weekends as needed
- School experience
- Spanish
- Microsoft Outlook
Quick Apply
12d
Patient Service Representative
Project Home —Philadelphia, PA
- $21.65 an hour
- Full-time
- Spanish
- HIPAA
- English
- Paid parental leave
- Disability insurance
Quick Apply
Part-Time Call Center - PAT Member Service Representative I - NE Philadelphia
American Heritage Credit Union —Philadelphia, PA
- $18 - $21 an hour
- Part-time
- Entry level
- 401(k) matching
Quick Apply
Surgical Services Associate - Surg Outpt SONC-HUP
Penn Medicine —Philadelphia, PA
- Full-time
- Surgery
- Mid-level
- Outpatient experience
- Tuition reimbursement
Quick Apply
Patient Access Rep - Evening Shift
Trinity Health Mid-Atlantic —Darby, PA
- Part-time
- Hospital
- Outpatient experience
- High school diploma or GED
- Health insurance
- Dental insurance
Client Coordinator
ExamWorks —Bala-Cynwyd, PA
- $25 an hour
- Extended hours
- Remote
- Microsoft Excel
- Microsoft Outlook
- Computer literacy
Quick Apply
5d

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Insurance and Denials Specialist

Careers at Gentell -
Morrisville, PA

Quick Apply

Job Details

Full-time
$23 - $25 an hour

Qualifications

Medicare
Insurance verification
Customer service
High school diploma or GED
ICD-10
Medicare regulations
Centers for Medicare and Medicaid Services (CMS)
Medical billing
Patient interaction
Cross-functional collaboration
Medical debt collection accounts

Full Job Description

Insurance and Denials Specialist

POSITION SUMMARY

Under the direction and support of the Insurance and Denials Manager, the Insurance and

Denials Specialist will initiate billing claims, actively process all denials, and ensure follow up on collection efforts to ensure timely reimbursement for services provided.

The Insurance and Denials Specialist require critical thinking skills, ability to identify

trends, and achieve departmental revenue goals. We are looking for someone who can

confidently gather the required information to submit and resolve health insurance claims

to multiple payers.

SUPERVISION RECEIVED

Insurance and Denials Manager

DIRECT REPORTS

Director of Compliance

ESSENTIAL DUTIES AND RESPONSIBILITIES

To perform this job successfully, an individual must be able to perform each essential duty

satisfactorily.

Registration of patients, insurance verification, HCPCS coding and ICD-10 coding
Verify all insurance orders for accuracy and completeness
Review clinical documentation to ensure compliance with payors guidelines
Apply correct modifiers and HCPCS to claims
Communicate with Gentell clinicians and customer facilities as needed to expedite claims processing
Transmit/submit claims (paper or electronic) to insurance payors for reimbursement
Contact insurance companies on outstanding claims
Maintain supporting chronological notes that detail actions taken to resolve outstanding account balances
Resolve insurance problems and patient issues that may have resulted from incorrect or incomplete information
Review received insurance payments for underpayment
Call insurance companies regarding any discrepancy in payments as needed
Process all appeal requests within the time frame required
Process approved adjustments
Maintain patient demographic information and data collection systems, including all billing/collection reports, queues, or diversions while remaining in accordance with payor and company policy guidelines
Research and resolve discrepancies, denials, and appeals. Use initiative and critical thinking to identify problems, recommend solutions to management, and set priorities.
Perform miscellaneous job-related duties as assigned

DESIRED MINIMUM QUALIFICATIONS

The requirements listed below are representative of the knowledge, skill and/or ability required for this position.

High school diploma or GED required; Associate degree preferred
2 years minimum experience in healthcare insurance billing, collections, and/or denials and appeals
Knowledge of HMO/PPO, Medicare, Medicaid, and other payer requirements and systems
Thorough knowledge of all private insurance rules and regulations as it relates to claims submission and/or denials and appeals
Knowledge of LCDs, Medicare Guidelines for DME, supplier standards for DME
Must be able to work effectively with patients/customers, company staff, and outside parties, such as insurance company representatives
Strong customer service orientation
Ability to work in strong collaboration with all internal and external team members, inside and outside of the Revenue Cycle department
Strong attention to detail and accuracy
Task oriented while performing in a fast-paced environment
Certification in Medical Billing/Coding a plus
1 year of Durable Medical Equipment billing experience preferred
Experience with wound care orders billing a plus
Knowledge of Brightree a plus

Pay: $23.00 - $25.00 per hour

Work Location: In person

Quick Apply

Refine Your Search

member service representative jobs in philadelphia pa

Insurance and Denials Specialist

Call Center Representative

Licensed Insurance Sales Representative (Remote / Home-Based)

Wealth Management Trainee (PA)

Member Service Representative

Customer Service Rep (Premier)

Customer Service Representative

Patient Services Representative - OB/GYN Millenium

Member Service Representative

Medical Secretary

Patient Care Coordinator

Member Service Representative I (PAT) - Call Center

Patient Service Representative

Customer Service Representative I

Operations Clerk

Patient Service Representative

Part-Time Call Center - PAT Member Service Representative I - NE Philadelphia

Surgical Services Associate - Surg Outpt SONC-HUP

Patient Access Rep - Evening Shift

Client Coordinator

I want to receive the latest job alert for member service representative in philadelphia pa

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