What are the responsibilities and job description for the Claims Senior Representative position at HireTalent?
Delivers specific delegated claims tasks assigned by a supervisor. Examines electronic claim denials to determine next action. Follows established departmental and / or corporate policies and procedures to resolve claims issues. Interacts with agents and / or patients by email and phone to correct claim form errors. Completes claim denials without direct supervision, seeks understanding of unfamiliar claims when necessary.
Ability to multi-task in multiple systems
Basic knowledge of health insurance billing
Knowledgeable in assessing explanation of benefits (EOBs) from insurance companies (payer portals)
Attention to detail
Ability to process a high volume of claims corrections, 100 claims per day
The ability to identify and resolve payment posting issues.
Consistently meets agreed-upon department metrics.
The ability to identify an overpayment and determine when a refund is due (patients / insurance).
The ability to research and resolve simple to complex issues and or escalate issues to management when necessary.
Provided excellent customer service to patients and insurance companies.
At least 1 year of experience in medical insurance billing
Ability to work independently and as part of a team.
This position includes fiduciary duty or access to financial systems : Yes
REQUIRED - Recent experience (within 2 years) with Athena Health
REQUIRED Basic Excel skills
REQUIRED Past experience using payer websites such as Availity
