SPECIAL ACCOUNTS REPRESENTATIVE III

Essential Functions

• Follows up on open claims in accordance with established guidelines.
• Reviews claims for completeness and compliance with billing guidelines.
• Works to resolution disputes and appeals 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.
• Remains 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.
• Assists Supervisor in the education of new employees, the monitoring of workflow in all areas of claims processing and payment posting within the Insurance Department.
• Accesses appropriate websites to obtain current carrier guidelines, verify eligibility and re-files claims if necessary.
• Acts as liaison to the department to ensure any special projects and requests are completed efficiently and correctly.
• Acts as resource to peers.
• Completes all appeals according to payer specific guidelines.
• Reviews clinical documentation for appeals and composes detailed formal appeal letters for payment.

Requirements

• High School graduate or equivalent.
• 3-6 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.

Qualifications

• Ability to assist new hires and others in detailed training processes.
• An aptitude to retain detailed information.
• Ability to be multi-tasked oriented, to prioritize and to produce an acceptable volume of work.
• Excellent organizational and problem-solving skills.
• Excellent communication skills, oral and written.
• Basic knowledge of Windows-base computer applications.
• Accurate typing rate of 40 wpm.
• Ability to operate the following equipment: computer, copier, fax, web based payer sites, and 10-key calculator.