The BMMSA Business Office is looking to add a full-time Insurance Representative to their team. As an Insurance Representative your sole focus and responsibility will be your assigned physician(s) insurance A/R. This function will include, but not be limited to, timely follow up on claims rejected or denied by our clearinghouse and/or the patient's insurance carrier, completion of investigations and appeals according to the prescribed policies of the carrier, communication of corrections required by internal clinical and non-clinical departments including charge entry and registration staff, and assisting patients in understanding their insurance related balances.
Functions/Responsibilities:
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Examination and timely follow up on unpaid claims
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Completions of investigations and/or appeals of rejected or denied claims
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Communication with department staff members regarding required items for claims corrections
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Identification of claims requiring managerial review and assistance
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Assisting patients in the understanding of insurance denials and/or their assigned cost sharing as needed
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Facilitate the identification or rejection and denial trends
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Make corrections to claims information including but not limited to CPT codes, DX codes, referrals, and authorizations as directed by the departments
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Completion of additional duties as assigned by management
Qualifications:
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High school diploma of GED required
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Previous insurance A/R experience preferred
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Ability to understand an insurance Explanation of Benefits including denial reason codes and the appropriate responses to those codes
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General knowledge of ICD-10 and CPT codes
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Customer Service
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Ability to communicate clearly and concisely
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Knowledge of insurances, coverage guidelines, and payment policies
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Self-starter with the ability to work independently in the furtherance of the goals of the team
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Experience with patient accounting and EMR software
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Intergy experience preferred
For questions or concerns, please contact Ali Gorson at 484-272-3270 ext. 3026