Special Accounts Representative III

Responsibilities

• Follow up on open claims in accordance with established guidelines.
• Review claims for completeness and compliance with billing guidelines.
• Resolve disputes and appeals of third-party denials.
• Contest charges that are not paid or underpaid with the carrier.
• Access available third-party and governmental online services.
• Document all actions within the system.
• Maintain a comprehensive understanding of clinic contracts, carrier-specific, state or federal governmental, HCFA, or CPT billing and reimbursement guidelines.
• Review bulletins, updates, etc., and maintain as reference/resource material.
• Understand how to enter insurance information into the billing system and remain current on new FSCs that are created.
• Review and edit registration information according to clinic policy.
• Cross-train in all areas within the Insurance Department.
• Assist supervisor in educating new employees and monitoring workflow in claims processing and payment posting.
• Access appropriate websites to obtain current carrier guidelines, verify eligibility, and refile claims if necessary.
• Act as liaison to ensure special projects and requests are completed efficiently and correctly.
• Act as a resource to peers.
• Complete all appeals according to payer-specific guidelines, review clinical documentation, and compose 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 knowledge.
• Current CPT and ICD-10 coding experience.

Qualifications

• Ability to assist new hires and others in detailed training processes.
• Aptitude to retain detailed information.
• Multi-task oriented with the ability to prioritize and produce an acceptable volume of work.
• Excellent organizational and problem-solving skills.
• Excellent oral and written communication skills.
• Basic knowledge of Windows-based computer applications.
• Accurate typing rate of 40 wpm.
• Ability to operate computer, copier, fax, web-based payer sites, and 10-key calculator.