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.
Qualifications Research Full Job Description Job Summary:
The AR Specialist will cross train in all aspects of the Central Billing Office but will have a primary role and also serve as backup across the department.
Job Responsibilities:
Reading, analyzing, and interpreting patient charts to determine correct codes and modifiers are used when generating claims from the EHR system. Conducting audits and coding reviews to ensure all documentation is accurate and precise. This may include communicating with providers and other staff regarding the treatment, testing, etc., to verify that all billable services have been accounted for. Checking claim rejections daily, which includes correcting and resubmitting as necessary. Identify and resolve all outstanding claim processing issues, which may include contacting insurance for claim status, filing appeals on denied claims, submitting corrected claims, communicating within the department to identify denial trends. Daily posting and balancing of insurance and patient payments received through various methods (ERAs, EFTs, lockbox deposits, live checks, insurance credit cards, recurring ACH payments, recurring credit card payments, etc.). Generating patient statements on a monthly basis. Make outbound courtesy calls to patients to collect on outstanding balances and/or acceptable payment arrangements per policy. Answer incoming phone calls from patients regarding balances due on their account, process patient payments, and/or make acceptable payment arrangements per policy Research returned mail to locate better address/attempt to collect balance due on account. Prepare non-collectable accounts to transfer to outside collection agency per policy. Assist in other duties as assigned. Excellent customer service skills are a must Strong understanding of CPT, ICD-10 and HCFA terminologies are highly preferred Ability to read and interpret an insurance explanation of benefit (EOB) is highly preferred Strong attention to detail and documentation skills are required Highly analytical, strong problem solving and research skills Excellent math, verbal, and communication skills Computer proficiency is highly preferred Must be a team player and willing to serve as a backup to other team members as needed
