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IBERIA MEDICAL CENTER

PFS Specialist II

Career Insights for Claims Representative

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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

Iberia Medical Center (IMC) in New Iberia, LA is looking for team members who will help advance our vision to be the premier hospital of choice for patients, physicians and employees. We've been caring for our community for over 60 years and offer many diverse career paths. Our new employees experience opportunities to learn and grow while caring for their families, friends and neighbors. IMC is currently hiring a Patient Financial Services (PFS) Support II position, Full-Time . In this role the candidate is responsible for resolving all unpaid claims including but not limited to Commercial Insurance, Medicare, Medicare Replacement, Workman’s Comp, Hospice, VA, or Medicaid claims assigned by the PFS Assistant Manager. Provides back-up coverage to the Commercial, Medicare and Medicaid Billers for billing or follow-up and to the Credit Balance Clerk as needed.
EDUCATION
High School Graduate or equivalent
TRAINING/EXPERIENCE 2-3
years previous hospital business office experience related to the filing and collection of Commercial and Medicaid claims.
WORK HOURS 8
00 am to 4:30 pm, Monday through Friday
PRINCIPLE TASKS, DUTIES, AND RESPONSIBILITIES
Resolves all assigned unpaid including but not limited to Commercial, Medicare, Medicare Replacement, Workman’s Comp, VA, Hospice, or Medicaid claims on the Monthly ATB reports and otherwise ensures that all these accounts are paid in a timely manner. Provides back-up coverage to the Commercial, Medicare and Medicaid Billers for billing or follow-up as needed. Provides back-up coverage to the Credit Balance Clerk as needed. Ensure that all unresolved issues for accounts on the Medicare, Medicaid and/or Commercial remittance advices are resolved on a weekly basis. Ensures that any assigned denials, requests for refiles, etc., that are received from insurance companies are followed-up on within 3-5 business days. Edits and otherwise prepares all Medicaid Claims to be filed on a daily basis; ensures that the transmission of claims is completed and received by Medicaid Assist with completion of the Medicare Credit Balance quarterly report Initial billing of all claims generated within the inpatient and outpatient Behavioral Health facility Assist with Contract Management underpayment appeals and research
COMPETITIVE BENEFITS
Great medical benefit plan Early access to earned wages Participation in robust state pension plan Dental, vision, life insurance, disability and more!