What are the responsibilities and job description for the Insurance Representative position at CAROLINA ASTHMA AND ALLERGY CENTER MASTER?
Job Details
Description
General Summary: A nonexempt position responsible for the proper and timely processing of claims and payments to providers.
Essential Job Responsibilities:
- Weekly review of claim edits reports and corrects the claim information such as (CPTs, valid ICD-10's, referring doctor name/UPIN #, modifiers, etc.).
- Work and corrects claim rejections from Navicure, correcting necessary data.
- Daily follow-up of aged and denied charges.
- Keep A/R Supervisor informed on all Payer problems.
- Contacting insurance carriers via phone or website.
- Handle patient and provider calls in reference to claims or statements.
- Answer and forward incoming calls in a timely manner.
- Identifies and resolves patient billing complaints.
- Performs various collection actions including contacting patients by phone, correcting, and resubmitting claims to third party payers.
- Identify and correct posting errors and overpayments.
- Review and correct COB errors.
- Other duties and projects as assigned.
- Occasional overtime may be required.
Qualifications
Education: Bachelor's degree in health or business administration.
Experience: Minimum two years of experience in claims processing in a health care setting.
Other Requirements: None
Performance Requirements:
Knowledge:
- Knowledge of clinic policies and procedures.
- Knowledge of health care insurance claim practices and compliance.
- Knowledge of computer systems, programs, and applications.
- Knowledge of medical terminology.
Skills:
- Skill in gathering and reporting claim information.
- Skill in trouble-shooting claim insurance problems.
- Skill in written and verbal communication and customer relations.
Abilities:
- Ability to work effectively with physicians, other medical staff, and external agencies.
- Ability to identify and analyze claim problems.
Equipment Operated: Standard office equipment including computers, fax machines, copiers, printers, telephones, etc.
Work Environment: Position is in a well-lighted office environment. Occasional evening and weekend work.
Mental/Physical Requirements: Involves sitting approximately 90 percent of the day, walking or standing the remainder.
