The responsibilities of this job include, but are not limited to, the following :

• Reviewing and addressing processed claims to ensure proper payments are received according to the payers' contract;
• Reviewing unprocessed claims within the payers' timely filing limits for resubmission of claims for payment;
• Researching Eligibility of Benefits (EOB) to verify correct payment and adjustments are posted to patient accounts;
• Researching Eligibility of Benefits (EOB) to determine if unpaid balances need to be appealed to the appropriate Workers' Compensation Committee;
• Correcting registrations on Workers' Compensation accounts and refiling claims;
• Maintaining the daily work flow goals established for the Occupational Health Insurance Representatives;
• Addressing account inquiries and / or update requests in a timely manner;
• Establishing and maintaining a working relationship with payer representatives to ensure proper claim filing and reimbursement;
• Effectively communicate trends or issues to the Occupational Health Operations Manager;
• Keeping informed of all changes relating to Workers' Compensation laws and requirements to ensure proper claim filing and payments;
• Working through accounts with outstanding balances and collecting from the responsible party;
• Following departmental and corporate policies and procedures;
• Responsible for the use and operation of the following equipment : telephone, copier, printer, fax, computer, billing system, Microsoft Office Suite, imaging system, and calculator.

Minimum education and professional requirements include, but are not limited to, the following :

• Employee must be 18 years of age or older;
• High school graduate or equivalent;
• Knowledge of Workers' Compensation laws and policies;
• Three years of experience working in the healthcare field, preferably in a medical billing department;
• Excellent analytical, written and verbal communication skills;
• Ability to prioritize, organize and multi-task in a timely manner;
• Ability to use Microsoft Excel, Outlook and Word;
• Must be able to sit for long periods of time;
• Must be able to use phone system.

Last updated : 2024-06-22