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;
- Researching denied claims or claims with no response to determine proper follow up steps be taken to obtain payment;
- 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.
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Maintaining the daily work flow goals established for the Occupational Health Insurance Representatives;. Effectively communicate trends or issues to the Occupational Health Operations Manager;. Establishing and maintaining a working relationship with payer representatives to ensure proper claim fil...
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