Special Accounts Representative II - Insurance Follow Up - Full Time

Essential Functions

• Follows up on open claims in accordance with established guidelines.
• Reviews claims for completeness and compliance with billing guidelines.
• Works to resolve disputes of third-party denials.
• Contests charges that are not paid or underpaid with the carrier.
• Accesses available third party and governmental on-line services.
• Documents all actions within the system.
• Possesses a comprehensive understanding of Clinic contracts, carrier specific, State or Federal governmental, HCFA, or CPT billing and reimbursement guidelines.
• Reviews bulletins, updates, etc., and maintains as reference/ resource material.
• Possesses a comprehensive understanding of how to enter insurance information into the billing system.
• Remain current on new FSC’s that are created and understand how they are used.
• Reviews and edits registration information according to clinic policy.
• Cross trains in all areas within the Insurance Department.
• Affords assistance to new hires and others in detailed training processes.
• Maintains an aptitude to retain detailed information.
• Is multi-tasked oriented, prioritizes, and produces an acceptable volume of work.
• Exhibits excellent organizational and problem-solving skills.
• Displays excellent communication skills, both oral and written.
• Shows basic knowledge of Windows-base computer applications.
• Displays an accurate typing rate of 40 wpm.
• Operates the following equipment: computer, copier, fax, web based payer sites, and 10-key calculator.

Requirements

• High School graduate or equivalent.
• 2-4 years in a medical business office or related field.
• Experience with the claims adjudication process for multiple governmental agencies and private insurance carriers.
• Basic medical terminology.
• Current CPT and ICD-10 coding experience.