Medical Claims Representative

Posting ID : A1068500867
Date Posted : 2015-08-19
Category : Customer Service

Claims Follow Up - primary responsibility will be calling on payers to collect payments for patient accounts.

Principal Duties and Responsibilities

1. Responsible for the accurate and timely filing of all third party claims on behalf of patients/guarantors.

2. Coordinates primary and secondary third party coverage and bills in accordance with regulations.

3. Codes and verifies the coding of diagnoses and procedures (ICD.9 and CPT.4) in compliance with third party requirements.

4. Keys and verifies the accuracy of charges and diagnoses.

5. Performs all routine and special follow-up on all assigned accounts using telephone and correspondence that affect collection of the account balance; negotiates payment terms; coordinates collection activities between patients, employers, and third parties.

6. Validates/audits claims and account details as necessary to support third party compliance and maximum reimbursement.

7. Maintains routine communication with physicians, staff and/or MBS to ensure effective handling of account balances.

8. Educates physicians and staff about billing regulations, changes, and reimbursement issues.

9. Documents all activity on accounts, including corrections, collection activities, etc.

10. Initiates account adjustments to correct account balances and/or comply with contractual requirements.

11. Evaluates uncollectible accounts and recommends referral to an outside collection agency.

12. Receives, responds, and documents all incoming account inquires, both telephone and correspondence.

13. Verifies accuracy of accounting between accounts receivable office, finance, and physician offices for month reconciliation.

14. Receives, sorts, distributes and/or processes all incoming correspondence received through mail deposit or lockbox.

15. Keys all payments, adjustments and other transactions.

16. Performs daily system update and month-end balancing.

17. Balances keyed data to batch controls and notes exceptions to balance data.

18. Handles Quadex editing reports.

19. Sends refunds with appropriate documentation.

20. Assists in supporting multiple physician offices as workload dictates.

21. Implements the behavior standards for PHN/PHS, including customer service and teamwork standards.

22. Responsible for other duties as assigned.


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