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Oceans Healthcare

Collections Specialist

Career Insights for Claims Representative

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Based on Louisiana data

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What they do

A Claims Representative accepts and reviews applications for insurance and provides information to insurance agents. Assists insurance customers, answers questions and processes requests to change or cancel policies. May assist with insurance claims that are disputed, review claims and policy coverage and help to negotiate agreements between customers and an insurance company.

$52,446 / year median in Louisiana

+5% projected growth

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Job Description

Benefits We Offer:
Medical, Dental, Vision Coverage (Multiple Plan Options) - Eligible first of the month after 30 days. 401 (k) Retirement Savings Plan with Discretionary Company Match Tuition Reimbursement Daily Pay Paid Time Off Competitive Market Compensation Short Term Disability, Long Term Disability Life Insurance Employee Assistance Program The Collector is responsible for accurate and timely billing and collection of outstanding receivables from third party payers and payer representatives. Maintaining accurate account balances in accordance with contractual obligations, fee schedules, or regulations is required job duty.
Essential Functions:
Reviews third party claims for accuracy and completeness using patient accounting functionality. Submitting claims to third party payers within timely filing restrictions. Performs follow up activities by telephone or electronic inquiry on accounts with outstanding third party payer balance to determine status of claims in accordance with payer specific follow-up guidelines. Attempts to expedite claim adjudication by resolving issues that may delay processing, involving the patient/guarantor as necessary. Clearly and concisely documents pertinent follow up activity upon completion of each occurrence in patient accounting system. Resubmits claims to payers as necessary - submitting secondary or tertiary plan claims as required. Ensures accurate account balances for proper account processing and reporting, requesting contractual allowances, adjustments , and balance transfers as necessary. Communicates with other revenue cycle staff members, Utilization Review/Case Management, and site leadership to ensure timely and accurate claims payments. Researches and resolves credit balance accounts as requested by payers or as identified on aging reports. Completes daily and weekly productivity/performance reporting as directed by management. Performs other duties and projects as assigned.