What are the responsibilities and job description for the Insurance Claims Representative - Full Time position at IRMC?
Key Responsibilities:
- Reviews and prepares claim processing to third party payers
- Prepares and submits electronic submission of claims transmission daily
- Prepares and submits non-electronic submission of claims transmission daily
- Processes verification of claims accuracy on electronic billing system
- Processes verification of claims transmitted from electronic billing system
- Produces and executes file creation and tracking of claim processing data
- Processes and assists in preparing appropriate documents such as spreadsheets for cost reporting purposes
- Requests accurate adjustments with supporting documentation
- Requests refunds to insurance carriers and patients
- Executes and produces claim follow up to include secondary billing processes
- Submits claims to secondary payers
- Responds to insurance carrier requests
- Responds to patient’s inquiries when needed
- Processes accurate charge correction and claim adjustments
- Possesses the ability to appropriately identify and update claims in hospital system
- Misc. Claims processing, communication and file maintenance of claims
- Possesses the ability to communicate using electronic media to multiple entities
- Processes and completes reports/duties assigned
- Communicates with other departments to ensure correct and accurate billing processes.
- Communicate, participate in training and development on the processes and related industry knowledge required to perform with a high degree of accuracy and timeliness.
- Maintain all updates related to performing the job functions with comprehensive information for any changes on industry regulations and payer requirements associated with the function.
- Ensure a high degree of customer service in the interaction with both direct and indirect customers in the completion of the functions.
- Responsible for managing processes established for the identification, communication and collection of patient liable balances and referring cases for financial counseling as appropriate.
- Monitor outcomes for compliance with process and policy, and customer service so to provide periodic feedback for reinforcement of compliance and corrective action for deficiencies.
- Identify process deficiencies or improvements and make recommendations to the Insurance Claims Supervisor
- Performs other duties and activities necessary to support the needs of the hospital and RC Pod operations;
- Completes hospital initiatives as they apply to the department.
- Participates in meetings and other methods of communication needed to determine root cause of issues and recommends corrective actions to the Insurance Claims Supervisor
- Assists in performing system configuration and table maintenance of the assigned systems.
- Performs system testing of updates and releases within the functional scope as assigned.
- Completes other duties as assigned.
Minimum Education Required: High School Diploma
Minimum Experience Required: At least 3 years of clerical experience is preferred. Computer skills required. Previous hospital insurance billing experience with the last six months preferred
Licensure/Certification: AAHAM certification after 1 yr Preferred
