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Medical Claims Review Representative

Medical Claims Review Representative

Midwest Orthopaedic ConsultantsOrland Park, IL, USA
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OBJECTIVE :

To ensure that all charges, claims and / or vouchers have been accurately submitted to the appropriate payers in a timely manner and that complete and accurate payment is received from all payers and self-pay patients.

ESSENTIAL DUTIES AND RESPPONSIBILITIES :

  • Review claims submissions for accuracy by confirming proper payer, authorizations, referrals and all other key billing components.
  • Follow clams from submission to payment using EMR analytics, reports, payer portals and other resources as necessary
  • Partner with third party billing company personnel to resolve billing issues and support the effort of submitting clean claims with any research in a timely and responsive manner
  • Review payer EOBs for a complete understanding of payments and assignment to patient responsibility.
  • Use your knowledge of health insurance claim processing, patient policies by payer and payer plan dynamics for commercial, governmental, worker's compensation, labor funds and others to assess accuracy of payments.
  • Work diligently to resolve denied / rejected claims by researching and determining the causes of the unpaid claims and making every effort to resolve the denial / rejection in order to promptly resubmit to the payer.
  • Respond to patient and / or insurer inquiries in a professional. timely efficient and knowledgeable fashion, ensuring HIPAA and MOC guidelines are followed. and / or refunds as necessary.
  • Other job tasks as necessary

COMPETENCIES :

  • Experience using EMR, EHR and other healthcare / billing related systems to include Allscripts, Mod Med, EPIC, Exscribe, Health Ipass etc., Experience with web portals such as Availity
  • Proficiency using Microsoft Excel
  • Thorough knowledge of medical insurance terminology and payer explanation of benefits and experience working withmedical benefit plans department of labor for workers comp claims
  • Experience with patient assistance and government programs such as Medicare and Medicaid
  • Proficient at multitasking and managing competing priorities effectively.
  • Effective written and oral communication.

    • EDUCATION AND EXPERIENCE REQUIRED :

  • Minimum HS diploma, college degree desired but not required
  • Four years direct experience with core competencies

    • WORKING CONDITIONS / PHYSICAL DEMANDS :

  • Must be able to sit and work at a computer for extended periods of time
  • Requires manual finger dexterity and vision corrected to normal range
  • Must be able to lift 25 lbs

    • Job Posted by ApplicantPro

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    Claim Representative • Orland Park, IL, USA