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Insurance Collection Rep-Pending Claims

Job ID 104813 Date posted 05/15/2017
Department: Healthcare Business Solutions
Schedule: Full time hourly non exempt - FH
Shift: Day
Hours: 40 Hours/Week, Monday-Friday 7:00 a.m. - 3:30 p.m.
Job Details:

  • 3 years of experience required
  • Position Summary:

    ·Insurance Collection Reprehensive will be responsible for follow up on outstanding, rejected or denied physician claims.

    ·Maintains thorough knowledge of Commercial and Government insurance carriers claim guidelines/requirements

    ·Processes rejections and denials to determine if the claim needs to be refilled or submitted for an appeal with the payer

    ·Accurately processes all approved adjustments and documents work performed.

    ·Maintains the department work productivity and error rate

    ·Communicates problems and concerns with team leader / manager which may lead to inaccurate or untimely completion of reimbursement processing.

    ·Maintain knowledge of ICD9/ICD10 diagnostic as well as CPT/HCPCS procedural coding.

    ·Can efficiently and effectively utilize payor websites to obtain payor guidelines/requirements as well as claim status and patient eligibility

    ·Is able to identify and resolve provider credentialing issues

    Performs similar, comparable, or other related duties as assigned.

    Qualifications:

    High school graduate or equivalent required. Must have 3 – 5 years' experience in processing and billing professional physician claims. Prior experience communicating with insurance companies and utilizing insurance websites. Clear understanding of Healthcare claims processing. Must be able to analyze payer trends and issues. Able to read and understand payer remittances. Knowledge and understanding of CMS 1500 and electronic 835and 837 formats. Medical billing certificate from an accredited university or vocational program preferred. Experience with ICD-9/ ICD10, CPT/HCPCS procedural coding and basic medical terminology required. . Solid problem-solving and analysis skills that demonstrate resourcefulness and attention to detail. Working knowledge of payer denials and appeals process. Prior Epic PB Resolute experience a plus.

    Akron Children's Hospital is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individual with Disabilities.

    EEO is the law, please click/copy paste the link below to learn more:

    http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf

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