Description:
Position Summary
The responsibilities include spotting and investigating details in insurance claims that may indicate insurance coverage abuse, fraud or unwarranted medical treatments or procedures. This includes manual posting of insurance and patient payments. Position reviews claims returned or rejected by government or supplemental insurance companies, and includes answering medical and customer inquiries regarding coverage.
Requirements:
Essential Duties and Responsibilities
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Efficiently posts patients’ and insurance payments manually by processing and posting patients’ credit cards or insurance information correctly.
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Efficiently and adequately posts insurance refunds if necessary.
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Monitors and posts import electronic remits, and thoroughly posts denials as well as clearly identifying what should be directed to the aging department for follow up.
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Knowledgeable and capable in finding, understanding or entering information for financial reports or other various types of documents such as the ability to read and understand EOB’s.
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Possess the knowledge of understanding electronic remittance summaries, knowing how to balance dialing posting figures, and printing daily financial reports after completing a batch.
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Proficient in client services by anticipating and responding to needs and demands of the client along with proficiency in contact with insurance carriers.
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Respond back to any emails that are sent throughout the day that need to be resolved in a timely manner.
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Accurately and in a timely manner, helps in the contribution to the distribution of mail via MedSpeed.
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Other duties as assigned
Supervisory Requirements
This position has no supervisory requirements.
Educational & Experience Qualifications
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Required: High school diploma or general education degree; or equivalent combination of education and experience.
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At least 3 years’ experience to successfully perform this job.
Additional Qualifications
To perform this job successfully, an individual should have the following general knowledge:
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Great understanding and excellent knowledge of all billing processes.
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Honest, ethical and compassionate behavior, takes responsibility for own actions and be forthright about errors or uncertainty, display flexibility, function effectively under stress, adapt to changing environment, and function as an active cooperative member of the revenue cycle team.
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Knowledgeable in current computer applications including new computer software and computer systems
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Proficient in ten-key, Microsoft Office programs including, but not limited to Outlook, Word and Excel.
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Excellent in verbal skills when handling situations where information is being relayed to customers, clients or employees. Proficient in written communication and mathematical skills with accuracy and attentiveness.
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Ensuring decisions are made based on policies, rules and organizational directives and solves emerging problems in a timely manner.
Qualifications
To perform this job successfully, an individual must be able to adequately perform each essential duty. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Knowledge Requirements To perform the job successfully an individual should demonstrate the following competencies:
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Communication: Using language as a flexible tool to share and collect information, exchanging ideas and openly exploring a variety of perspectives adjusting style and content to each unique individual, audience and circumstance.
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Computer Use: Using computers and other forms of technology
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Conflict Resolution: Facilitating the prevention and/or resolution of conflict while preserving working relationships.
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Creative Thinking: Discovering new opportunities and solutions for problems by looking beyond current practices and using innovative thinking.
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Decision Making/Decisiveness: Making and taking responsibility for, and demonstrating commitment to appropriate decisions in a timely manner. Ensuring that decisions are made based on policies, rules and organizational directives and solving the emerging problems.
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Document Use: Finding, understanding or entering information (e.g. text, symbols, and numbers) in various types of documents, such as tables or forms.
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Engagement: Mobilizing people, organizations and partners in developing goals, executing plans and delivering results. Laying the groundwork for success by building coalitions with key players and building momentum by communicating clearly and consistently. Using negotiation skills and adaptability to encourage recognition of joint concerns, collaboration and to influence the success of outcomes.
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Innovation/Initiative: Using information from a variety of sources, identifying immediate action needed to address current issues, seizing the opportunity to enhance performance and advance horizontal/vertical goals. Attending to imminent issues while maintaining an awareness of emerging opportunities.
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Interpersonal Relations: Establishing and maintaining harmonious professional relations by demonstrating respect for and sensitivity to others.
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Learning Support/Continuous Learning: Creating a learning environment by promoting training and professional development.
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Numeracy: Using numbers and thinking in quantitative terms to complete tasks.
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Organizational Knowledge: Understanding the role of the department and job functions within the organization.
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Problem Solving: Ensuring that decisions are made based on policies, rules and organizational directives and solving the emerging problems.
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Relationship/Network Building: Building and maintaining effective and constructive working relationships, partnerships or networks of contacts with people who are, or might someday be, instrumental in achieving work-related goals.
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Self Confidence/Self Esteem: Believing in one's own capability to select an effective approach to accomplish a task or activity in increasingly challenging circumstances.
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Teamwork/Cooperation: Readily sharing information, knowledge and personal strengths. Seeking to understand and building on differing perspectives of others to enhance team efficiency and quality outcomes.
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Values and Ethics: Serving the Company with integrity and respect in personal and organizational practices. Includes respecting democratic, professional, ethical and people values. Building respectful, bilingual, diverse and inclusive workplaces. Ensuring decisions and transactions are transparent and fair. Holding themselves, their employee and their department accountable for their actions.
Communication Skills
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of the organization.
Reasoning Skills & Abilities
Ability to apply principles of logical or scientific thinking to a wide range of intellectual and practical problems. Ability to deal with nonverbal symbolism (formulas, scientific equations, graphs, musical notes, etc.,) in its most difficult phases. Ability to deal with a variety of abstract and concrete variables.
Mathematical Skills
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry.
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing duties of this job, the employee is frequently required to sit, stand, walk, lift up to 10 pounds, and use his or her hands to complete various tasks. The use of finger dexterity such as typing is required.
Must be capable to talk and listen to hear and carry conversations with others, whether it is phone related or in person.
Work Environment
This position has no harmful environmental conditions or any exposure to harmful products. The noise level in the work environment is usually moderate as found in an office environment. The contributors of the noise level are mainly copiers, computer equipment, and phones which are presented in the office throughout the job duties.
Comments
This description is intended to describe the essential job functions, the general supplemental functions, and the essential requirements for the performance of this job. It is not an exhaustive list of all duties, responsibilities, and requirements of a person so classified. Other functions may be assigned and management retains the right to add or change the duties at any time.