What are the responsibilities and job description for the Medical Billing Representative position at Behavioral Health Network, Inc (BHN)?
Brief Description
Medical Claim Submission Representative
Summary
The Medical Claim Submission Representative is primarily responsible for reviewing and submitting accurate claims to all payers for BHN providers. The Medical Claim Submission Representative is expected to execute the responsibilities of the position while meeting established deadlines. The Medical Claim Submission Representative is responsible for reviewing pending charges, approving, batching, and submitting all unbilled claims for services rendered to the individual insurance plan daily.
The objective of this position is for the assigned insurance plan to accept a claims batch and submit payment. To accomplish this, the Medical Claim Submission Representative handles all rejections and acknowledgments, guaranteeing the acceptance of all acknowledged claims currently pending payment or processing.
ESSENTIAL JOB FUNCTIONS*
BHN maintains its commitment to social justice and diversity and strongly encourages diverse candidates to apply.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Medical Claim Submission Representative
Summary
The Medical Claim Submission Representative is primarily responsible for reviewing and submitting accurate claims to all payers for BHN providers. The Medical Claim Submission Representative is expected to execute the responsibilities of the position while meeting established deadlines. The Medical Claim Submission Representative is responsible for reviewing pending charges, approving, batching, and submitting all unbilled claims for services rendered to the individual insurance plan daily.
The objective of this position is for the assigned insurance plan to accept a claims batch and submit payment. To accomplish this, the Medical Claim Submission Representative handles all rejections and acknowledgments, guaranteeing the acceptance of all acknowledged claims currently pending payment or processing.
ESSENTIAL JOB FUNCTIONS*
- Effectively manages a portfolio of assigned claim types.
- Updates and maintains claim files to ensure complete and accurate records.
- Effectively reviews claims to ensure claims are rolling up correctly.
- Reviews claims to ensure that required modifiers and all fields are present before approval.
- Accurately batches and approves assigned claim batches.
- Effectively reviews and reprocesses rejected claims on a daily basis.
- Reviews the acknowledgment folder daily to verify that acknowledged claims have been accepted.
- Identifies notification issues, coordinates resolution, and takes corrective actions, as needed.
- Maintains action plans to ensure required payer submission deadlines are met and moves the file toward prompt and appropriate resolution. Escalates issues, as needed.
- Works with the Claims Submission Team to facilitate information and resolve charge questions.
- Collaborates on special projects.
- Other duties as assigned.
BHN maintains its commitment to social justice and diversity and strongly encourages diverse candidates to apply.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
