MEDICAL CLAIMS REPRESENTATIVE

Job Summary: The Medical Claims Representative assists in the management of the Revenue Cycle process for their assigned practices while adhering to set processes and maintaining set productivity and accuracy standards. This includes accurate and timely claim creation, follow-up and correspondence with providers, insurance payers and patients. Maintains data quality and integrity. Carries out all duties while maintaining compliance and confidentiality, promoting the mission and philosophy of the organization, and fostering a professional, positive work environment.

Career Band: O1 – Operations

·      Acquires basic skills to perform routine tasks.

·      Work is prescribed and completed with little autonomy.

·      Works with either close supervision or under clearly defined procedures

·      Has developed knowledge and skills through formal training or considerable work experience.

·      Entry level often for those with work experience in the skill area

·      Works within established procedures with a moderate degree of supervision

·      Identifies the problem and all relevant issues in straightforward situations, assesses each using standard procedures and makes sound decisions.

·      Displays a sense of urgency when completing daily job functions.

Supervisory Responsibilities:

·      This position holds no supervisory responsibilities.

Duties/Responsibilities:

·      Prepares and submits clean claims to third party payers either electronically or by paper.

·      Assists in identifying and resolving claim related issues.

·      Denial and insurance follow-up management

·      Issues adjusted, corrected and/or rebilled claims to third party payers.

·      Posts adjustments transfer of responsibility and refunds, as necessary.

·      Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.

·      Assists with patient queries/questions.

·      Communicates any issues/delays within the Revenue Cycle to the appropriate Advanced Biller.

·      Other duties as assigned.

·      Stay up to date on current coding requirements.

·      Work to set and achieve monthly S.M.A.R.T goals.

·      Ensure productivity standards are met.

·      Ensure Client KPI’s are met.

Required Skills/Abilities:

·      Knowledge of medical billing/collection practices preferred but not required.

·      Experience in banking/accounting preferred but not required.

·      Experience in the medical field preferred but not required.

·      Strong keyboard skills.

·      Works well in environment with firm deadlines; results oriented.

·      Performs multiple tasks effectively.

·      Able to work both independently and as part of a team.

·      Strong analytical skills required.

·      Excellent organizational skills.

·      Proficiency in Microsoft Office Suite.

Personal Characteristics impacting performance.

1.      Personal Character

2.      Verbal/written Communication Skills

3.      Focus on Culture.

4.      Extreme ownership

5.      Overall Process Focus

6.      Metrics Skills

7.      System Knowledge

8.      Regulatory/Billing Knowledge

9.      Customer Focus and Communication

10.  Professional Demeanor and Appearance

11.  Sense of Urgency

12.  Compliance

13.  Solution driven.

Education and Experience:

·      High school diploma or equivalent