Account Rep II, Commercial - Clinical Practice Services

Primary Responsibilities

• Reply to requests for information from insurance companies.
• Pull the appropriate medical records to submit for claims payment and ensure all proper documentation is present and accurate.
• Apply extensive knowledge of multiple contracts, agreements and government guidelines/regulations to submit, post, research and/or resolve accounts or claims.
• Communicate via phone with various representatives, both internally and externally.
• Analyze multiple sources of remittance to determine proper allocation of rejections, payments and/or adjustments, subject to individual carrier guidelines and contractual fee schedules.
• Respond to carrier requests for additional information or documentation.
• Review carrier denials and/or unacceptable reimbursement to (a) challenge the determination or (b) adjust appropriately.
• Review and update registration to correspond with information received from payer.
• Copy and forward remittance advice to appropriate team for follow-up.
• Identify and escalate contractual carrier issues to the appropriate source.
• Assist training Clerks.
• Perform necessary billing activities such as claims to maintain team goals or assist other teams.

Qualifications

• High school diploma.
• 3 years of experience.
• Customer Service and/or Medical Billing experience preferred.
• EPIC experience preferred.