A Claims Adjuster or Specialist investigates and evaluates insurance claims. Specializes in a particular type of insurance. Inspects property damage, including damage to homes, buildings and cars; reviews claims after they are submitted; may authorize or deny payment for claims. May work directly for insurers or on behalf of claimants.
Responsible for follow-up of all third-party claims to assure maximum reimbursement for services rendered by Frontier Health staff. Must exercise sound judgment, demonstrate initiative, develop and maintain good working relationships with all corporation staff and clients.
EDUCATION AND EXPERIENCE
:
Education:
High School Diploma/GED required.
Licensure:
N/A Certification:
N/A Experience:
Medical billing experience preferred.
Knowledge/Skills:
ICD-10, CPT, DSM-V, and HCPCS coding knowledge. Excellent verbal/written communication skills. Skilled in use of all major computer applications, especially Excel. Able to work independently and as a team player.
EQUIPMENT
Computer, fax, copier, calculator and any other equipment required to perform the functions of the position.
MAJOR DUTIES AND RESPONSIBILITIES
1. Responsible for follow-up of all third-party claims in a timely fashion. 2. Assures guidelines and billing procedures are followed. 3. Identifies problem accounts and works with Utilization Management to maximize revenue. 4. Responsible for re-billing appropriate charges to the next responsible funding source. 5. Must obtain and maintain knowledge of all collection policies and procedures. 6. Must obtain and maintain knowledge of all services rendered by the agency and the liability of each third-party contract. 7. Must have or obtain working knowledge of CPT coding, revenue coding, HCPCS coding, DSM-V, and ICD-10 coding. 8. Attend and participate in regularly scheduled staff meetings and in-services and individual program planning staffings as needed. 9. Maintains records and prepares reports related to Accounts Receivable follow-up for applicable payors. 10. Responds to questions, telephone calls and letters for follow-up of accounts and documents as necessary. 11. Works with supervisor or other team members 12. All other duties as assigned.
PERFORMANCE RESPONSIBILITIES
Although each position has its own unique duties and responsibilities, the following listing applies to every employee. All employees of the organization are expected to: 1. Support the organization's mission, vision, and values of excellence and competence, collaboration, innovation, commitment to our community, and accountability and ownership. 2. Exercise necessary cost control measures. 3. Maintain positive internal and external customer service relationships. 4. Demonstrate effective communication skills by conveying necessary information accurately, listening effectively and asking questions when clarification is needed. 5. Plan and organize work effectively and ensure its completion. 6. Demonstrate reliability by arriving to work on time and utilizing effective time management. 7. Meet all productivity requirements. 8. Demonstrate team behavior and must be willing to promote a team-oriented environment. 9. Represent the organization professionally at all times. 10. Demonstrate initiative and strive to continually improve processes and relationships. 11. Follow all Frontier Health rules, policies and procedures as well as any applicable laws and standards. Frontier Health is a Trauma-Informed Workplace. At Frontier Health, we prioritize a culture of safety, trust, support, and inclusion . As a trauma-informed workplace, we foster a supportive environment where every employee is valued, supported, and empowered to thrive.
