Full Time | Ambulatory Healthcare Services7 Months Ago
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Midwest Orthopaedic Consultants is Hiring a Medical Claims Review Representative Near Orland, IL
ObjectiveTo ensure that all charges, claims and/or vouchers have been accurately submitted to the appropriate payers in a timely manner and that complete and accurate payment is received from all payers and self-pay patients. Essential Duties And Respponsibilities
Review claims submissions for accuracy by confirming proper payer, authorizations, referrals and all other key billing components.
Follow clams from submission to payment using EMR analytics, reports, payer portals and other resources as necessary
Partner with third party billing company personnel to resolve billing issues and support the effort of submitting clean claims with any research in a timely and responsive manner
Review payer EOBs for a complete understanding of payments and assignment to patient responsibility.
Use your knowledge of health insurance claim processing, patient policies by payer and payer plan dynamics for commercial, governmental, worker's compensation, labor funds and others to assess accuracy of payments.
Work diligently to resolve denied/rejected claims by researching and determining the causes of the unpaid claims and making every effort to resolve the denial/rejection in order to promptly resubmit to the payer.
Respond to patient and/or insurer inquiries in a professional. timely efficient and knowledgeable fashion, ensuring HIPAA and MOC guidelines are followed. and /or refunds as necessary.
Other job tasks as necessary
Competencies
Experience using EMR, EHR and other healthcare/billing related systems to include Allscripts, Mod Med, EPIC, Exscribe, Health Ipass etc., Experience with web portals such as Availity
Proficiency using Microsoft Excel
Thorough knowledge of medical insurance terminology and payer explanation of benefits and experience working withmedical benefit plans department of labor for workers comp claims
Experience with patient assistance and government programs such as Medicare and Medicaid
Proficient at multitasking and managing competing priorities effectively.
Effective written and oral communication.
Education And Experience Required
Minimum HS diploma, college degree desired but not required
Four years direct experience with core competencies
Working Conditions/Physical Demands
Must be able to sit and work at a computer for extended periods of time
Requires manual finger dexterity and vision corrected to normal range